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Elhag A, Raslan A, Fayez F, Albanna Q, Khan A, Robinson L, Marchi F, Vergani F, Gullan R, Bhangoo R, Lavrador JP, Ashkan K. To scan or not to scan? A retrospective cohort study analysing the efficacy of routine post-operative CT after brain biopsy. Acta Neurochir (Wien) 2024; 166:288. [PMID: 38980421 DOI: 10.1007/s00701-024-06180-1] [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: 06/01/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE Postoperative management following elective cranial surgery, particularly after biopsy procedures, varies significantly across neurosurgical centres. Routine postoperative head CT scans, traditionally performed to detect complications such as intracranial bleeding or cerebral oedema, lack substantial evidence supporting their necessity. METHODS This study is a retrospective cohort analysis conducted at a regional neurosurgical department of 236 patients who underwent brain biopsies between 2018 and 2022. Patient data, including demographics, surgical details, and postoperative outcomes, were collected and analysed. The outcomes investigated were the incidence and impact of postoperative CT scans on time to discharge, management changes, and the influence of preoperative anticoagulation. RESULTS Out of 236 patients, 205 (86.86%) underwent postoperative CT scans. There was no significant relationship between postoperative hematoma, as detected on a CT scan, and neurological deficit (p = 0.443), or between preoperative anticoagulation and postoperative bleeding on CT scans (p = 0.464). Patients who had postoperative CT scans had a significantly longer length of stay (LOS) compared to those who did not (p < 0.001). Intraoperative bleeding was a predictor of hematoma on postoperative CT (p = 0.017) but not of postoperative neurological deficit. The routine postoperative CT scan showed limited predictive value for symptomatic deficits, with a positive predictive value of 6.67% and a negative predictive value of 96.88%. CONCLUSIONS Routine postoperative CT scans after brain biopsies do not significantly impact management or improve patient outcomes but are associated with longer hospital stays. CT scans should be reserved for patients showing clinical signs of complications rather than used as a routine procedure after a brain biopsy.
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Affiliation(s)
- Ali Elhag
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Ahmed Raslan
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - Feras Fayez
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Qusai Albanna
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Azharul Khan
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Louisa Robinson
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Francesco Marchi
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Francesco Vergani
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Richard Gullan
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Ranjeev Bhangoo
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
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He Q, Lin FX, Su JY, Zhuo LY, Zhu Q, Sun XC, Jiang RC, Yao ZG, Wang L, Dang YW, Liu DZ, Liu Y, Fang WH, Wang FY, Lin YX, Wang AX, Wang DL, Kang DZ. Naoxueshu Oral Liquid Accelerates Post-Craniotomy Hematoma Absorption in Patients: An Open-Label, Multicenter, and Randomized Controlled Trial. Chin J Integr Med 2024:10.1007/s11655-024-3902-6. [PMID: 38570473 DOI: 10.1007/s11655-024-3902-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To investigate whether Naoxueshu Oral Liquid (NXS) could promote hematoma absorption in post-craniotomy hematoma (PCH) patients. METHODS This is an open-label, multicenter, and randomized controlled trial conducted at 9 hospitals in China. Patients aged 18-80 years with post-craniotomy supratentorial hematoma volume ranging from 10 to 30 mL or post-craniotomy infratentorial hematoma volume less than 10 mL, or intraventricular hemorrhage following cranial surgery were enrolled. They were randomly assigned at a 1:1 ratio to the NXS (10 mL thrice daily for 15 days) or control groups using a randomization code table. Standard medical care was administered in both groups. The primary outcome was the percentage reduction in hematoma volume from day 1 to day 15. The secondary outcomes included the percentage reduction in hematoma volume from day 1 to day 7, the absolute reduction in hematoma volume from day 1 to day 7 and 15, and the change in neurological function from day 1 to day 7 and 15. The safety was closely monitored throughout the study. Moreover, subgroup analysis was performed based on age, gender, history of diabetes, and etiology of intracerebral hemorrhage (ICH). RESULTS A total of 120 patients were enrolled and randomly assigned between March 30, 2018 and April 15, 2020. One patient was lost to follow-up in the control group. Finally, there were 119 patients (60 in the NXS group and 59 in the control group) included in the analysis. In the full analysis set (FAS) analysis, the NXS group had a greater percentage reduction in hematoma volume from day 1 to day 15 than the control group [median (Q1, Q3): 85% (71%, 97%) vs. 76% (53%, 93%), P<0.05]. The secondary outcomes showed no statistical significance between two groups, either in FAS or per-protocol set (P>0.05). Furthermore, no adverse events were reported during the study. In the FAS analysis, the NXS group exhibited a higher percentage reduction in hematoma volume on day 15 in the following subgroups: male patients, patients younger than 65 years, patients without diabetes, or those with initial cranial surgery due to ICH (all P<0.05). CONCLUSIONS The administration of NXS demonstrated the potential to promote the percentage reduction in hematoma volume from day 1 to day 15. This intervention was found to be safe and feasible. The response to NXS may be influenced by patient characteristics. (Registration No. ChiCTR1800017981).
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Affiliation(s)
- Qiu He
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350209, China
| | - Fu-Xin Lin
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350209, China
- Clinical Research and Translation Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Fujian Clinical Research Center for Neurological Diseases, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - Jin-Ye Su
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350209, China
| | - Ling-Yun Zhuo
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350209, China
- Clinical Research and Translation Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Fujian Clinical Research Center for Neurological Diseases, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - Qing Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215000, China
| | - Xiao-Chuan Sun
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, China
| | - Rong-Cai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300000, China
| | - Zhi-Gang Yao
- Department of Neurosurgery, The Third Hospital of Shijiazhuang, Shijiazhuang, 050000, China
| | - Lei Wang
- Department of Neurosurgery, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei Province, 443000, China
- Department of Neurosurgery, Yichang Central People's Hospital, Yichang, Hubei Province, 443000, China
| | - Yan-Wei Dang
- Department of Neurosurgery, Xiangyang No. 1 People's Hospital Affiliated to Hubei University of Medicine, Xiangfan, Hubei Province, 441100, China
| | - De-Zhong Liu
- Department of Neurosurgery, Zhoukou Central Hospital, Zhoukou, Henan Province, 466000, China
| | - Yang Liu
- Department of Neurosurgery, The Third Hospital of Mianyang, Mianyang, Sichuan Province, 621000, China
| | - Wen-Hua Fang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350209, China
- Clinical Research and Translation Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Fujian Clinical Research Center for Neurological Diseases, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - Fang-Yu Wang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350209, China
- Clinical Research and Translation Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Fujian Clinical Research Center for Neurological Diseases, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - Yuan-Xiang Lin
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350209, China
- Clinical Research and Translation Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Fujian Clinical Research Center for Neurological Diseases, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - An-Xin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100000, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100000, China
- Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, 100000, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100000, China
| | - Deng-Liang Wang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350209, China
- Clinical Research and Translation Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Fujian Clinical Research Center for Neurological Diseases, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - De-Zhi Kang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China.
- Department of Neurosurgery, Binhai Branch of National Regional Medical Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350209, China.
- Clinical Research and Translation Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China.
- Fujian Clinical Research Center for Neurological Diseases, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China.
- Fujian Provincial Institutes of Brain Disorders and Brain Sciences, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China.
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Biswas K, Agrawal S, Gupta P, Arora R. Evaluation of risk factors for postoperative neurologic intensive care admission after brain tumor craniotomy: A single-center longitudinal study. J Anaesthesiol Clin Pharmacol 2024; 40:217-227. [PMID: 38919448 PMCID: PMC11196047 DOI: 10.4103/joacp.joacp_323_22] [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: 09/04/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 06/27/2024] Open
Abstract
Background and Aims Perioperative variable parameters can be significant risk factors for postoperative intensive care unit (ICU) admission after elective craniotomy for intracranial neoplasm, as assessed by various scoring systems such as Cranio Score. This observational study evaluates the relationship between these factors and early postoperative neurological complications necessitating ICU admission. Material and Methods In total, 119 patients, aged 18 years and above, of either sex, American Society of Anesthesiologists (ASA) grades I-III, scheduled for elective craniotomy and tumor excision were included. The primary objective was to evaluate the relationship between perioperative risk factors and the incidence of early postoperative complications as a means of validation of the Cranio Score. The secondary outcomes studied were 30-day postoperative morbidity/mortality and the association with patient-related risk factors. Results Forty-five of 119 patients (37.82%) required postoperative ICU care with the mean duration of ICU stay being 1.92 ± 4.91 days. Tumor location (frontal/infratemporal region), preoperative deglutition disorder, Glasgow Coma Scale (GCS) less than 15, motor deficit, cerebellar deficit, midline shift >3 mm, mass effect, tumor size, use of blood products, lateral position, inotropic support, elevated systolic/mean arterial pressures, and duration of anesthesia/surgery were associated with a higher incidence of ICU care. Maximum (P = 0.035, AOR = 1.130) and minimum systolic arterial pressures (P = 0.022, Adjusted Odds Ratio (AOR) = 0.861) were the only independent risk factors. Cranio Score was found to be an accurate predictor of complications at a cut-off point of >10.52%. The preoperative motor deficit was the only independent risk factor associated with 30-day morbidity (AOR = 4.66). Conclusion Perioperative hemodynamic effects are an independent predictor of postoperative ICU requirement. Further Cranio Score is shown to be a good scoring system for postoperative complications.
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Affiliation(s)
- Konish Biswas
- Department of Anaesthesiology, Sri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
| | - Sanjay Agrawal
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Priyanka Gupta
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rajnish Arora
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Heino I, Sajanti A, Lyne SB, Frantzén J, Girard R, Cao Y, Ritala JF, Katila AJ, Takala RS, Posti JP, Saarinen AJ, Hellström S, Laukka D, Saarenpää I, Rahi M, Tenovuo O, Rinne J, Koskimäki J. Outcome and survival of surgically treated acute subdural hematomas and postcraniotomy hematomas - A retrospective cohort study. BRAIN & SPINE 2023; 3:102714. [PMID: 38105801 PMCID: PMC10724206 DOI: 10.1016/j.bas.2023.102714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023]
Abstract
Background The morbidity and mortality of acute subdural hematoma (aSDH) remains high. Several factors have been reported to affect the outcome and survival of these patients. In this study, we explored factors potentially associated with the outcome and survival of surgically treated acute subdural hematoma (aSDH), including postcraniotomy hematomas (PCHs). Methods This retrospective cohort study was conducted in a single tertiary university hospital between 2008 and 2012 and all aSDH patients that underwent surgical intervention were included. A total of 132 cases were identified for collection of demographics, clinical, laboratory, and imaging data. Univariate and multivariable analyses were performed to assess factors associated with three-month Glasgow Outcome Scale (GOS) and survival at one- and five-year. Results In this study, PCH (n = 14, 10.6%) was not associated with a worse outcome according to the 3- month GOS (p = 0.37) or one (p = 0.34) and five-year (p = 0.37) survival. The multivariable analysis showed that the volume of initial hematoma (p = 0.009) and Abbreviated Injury Scale score (p = 0.016) were independent predictors of the three-month GOS. Glasgow Coma Scale (GCS) score (p < 0.001 and p = 0.037) and age (p = 0.048 and p = 0.003) were predictors for one and five-year survival, while use of antiplatelet drug (p = 0.030), neuroworsening (p = 0.005) and smoking (p = 0.026) were significant factors impacting one year survival. In addition, blood alcohol level on admission was a predictor for five-year survival (p = 0.025). Conclusions These elucidations underscore that, although PCHs are pertinent, a comprehensive appreciation of multifarious variables is indispensable in aSDH prognosis. These findings are observational, not causal. Expanded research endeavors are advocated to corroborate these insights.
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Affiliation(s)
- Iiro Heino
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
| | - Antti Sajanti
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
| | - Seán B. Lyne
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Janek Frantzén
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
| | - Romuald Girard
- Neurovascular Surgery Program, Section of Neurosurgery, The University of Chicago Medicine and Biological Sciences, (5841 S. Maryland), Chicago, IL, 60637, USA
| | - Ying Cao
- Department of Radiation Oncology, Kansas University Medical Center, Kansas City, KS, 66160, USA
| | - Joel F. Ritala
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
| | - Ari J. Katila
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
| | - Riikka S.K. Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
| | - Jussi P. Posti
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
- Neurocenter, Turku Brain Injury Center, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
- Department of Clinical Neurosciences, University of Turku, P.O. Box 52 (Kiinamyllynkatu 4-8), FI-20520, Turku, Finland
| | - Antti J. Saarinen
- Department of Paediatric Orthopaedic Surgery, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
| | - Santtu Hellström
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
| | - Dan Laukka
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
| | - Ilkka Saarenpää
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
| | - Melissa Rahi
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
| | - Olli Tenovuo
- Neurocenter, Turku Brain Injury Center, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
- Department of Clinical Neurosciences, University of Turku, P.O. Box 52 (Kiinamyllynkatu 4-8), FI-20520, Turku, Finland
| | - Jaakko Rinne
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
| | - Janne Koskimäki
- Neurocenter, Department of Neurosurgery, Turku University Hospital and University of Turku, P.O. Box 52 (Hämeentie 11), FI-20521, Turku, Finland
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West T, Driver CN, D'Souza RS. Incidence of Neuraxial and Non-Neuraxial Hematoma Complications From Spinal Cord Stimulator Surgery: Systematic Review and Proportional Meta-Analysis. Neuromodulation 2023; 26:1328-1338. [PMID: 35985940 DOI: 10.1016/j.neurom.2022.07.005] [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: 05/05/2022] [Revised: 06/17/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The goal of this meta-analysis was to estimate the incidence of total hematomas, neuraxial hematomas, and non-neuraxial hematomas in patients who underwent temporary spinal cord stimulator (SCS) lead trial placement and permanent implantation of SCS leads and internal pulse generator (IPG). MATERIALS AND METHODS A comprehensive search was conducted of databases of any publications before October 21, 2021. Eligible study designs included randomized control trials and prospective or retrospective observational studies with more than ten patients. The primary outcome variables were the incidences of total hematomas, neuraxial hematomas, and non-neuraxial hematomas in patients with SCS. These dichotomous categorical outcomes were abstracted from studies after Freeman-Tukey arcsine square root transformation using random-effects meta-analysis (DerSimonian and Laird method). Pooled incidence rates and 95% CIs were calculated for each outcome variable. RESULTS A total of 40 studies met the inclusion criteria. Included in the neuraxial and non-neuraxial hematoma analyses were 4751 patients and 3862 patients, respectively. The pooled incidence of any hematoma in patients with SCS was 0.81% (95% CI, 0.45%-1.27%). The pooled incidence of neuraxial hematoma in patients with SCS was 0.32% (95% CI, 0.18%-0.50%). This included primarily epidural hematomas (11/4751) but also comprised an intracranial hemorrhage in a patient on enoxaparin bridge therapy from warfarin and one patient not on anticoagulation with an intracranial subdural hematoma that resulted in death. The pooled incidence of non-neuraxial hematomas in patients with SCS was 0.59% (95% CI, 0.29%-1.00%). CONCLUSION The overall incidence of hematomas in patients with temporary SCS trial lead placement and permanent SCS/IPG implantations is less than 1%. Furthermore, the incidence of neuraxial hematomas is less than 0.5%, which is of particular interest given the potential devastating consequences of this complication. The results of this study can be used to inform patients and implanting physicians on hematoma complications from SCS and highlight that the benefits of SCS outweigh the hematoma risks if anticoagulation is appropriately managed perioperatively.
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Affiliation(s)
- Tyler West
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - C Noelle Driver
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
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Bedioui A, Elia A, Still M, Aboubakr O, Leclerc A, Planet M, Simboli GA, Moiraghi A, Fathallah H, Parraga E, Benevello C, Dezamis E, Roux A, Zanello M, Pallud J. Predictors of postoperative epidural hematomas after custom-made porous hydroxyapatite cranioplasty: a single-center experience of 194 consecutive cases. Neurosurg Rev 2023; 46:132. [PMID: 37264174 DOI: 10.1007/s10143-023-02039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/07/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
Cranioplasty is important for improving cosmesis and functional recovery after decompressive craniectomy. We assessed the incidence and predictors of post-cranioplasty epidural hematomas requiring surgical evacuation. A single-institution, retrospective study enrolled 194 consecutive patients who underwent a cranioplasty using custom-made hydroxyapatite between February 2008 and April 2022. Variables associated with postoperative epidural hematoma requiring surgical evacuation at the p < 0.1 level in unadjusted analysis were entered into multivariable analyses. Nine patients (4.6%) experienced postoperative epidural hematomas requiring evacuation, with time interval between craniectomy and cranioplasty <6 months (adjusted odds ratio (aOR), 20.75, p = 0.047), cranioplasty-to-bone shift > half of the bone thickness (aOR, 17.53, p = 0.008), >10 mm difference between pre-cranioplasty and post-cranioplasty midline brain shift contralateral to the cranioplasty (aOR, 17.26, p < 0.001), and non-resorbable duraplasty (aOR, 17.43, p = 0.011) identified as independent predictors. Seventeen patients (8.8%) experienced post-cranioplasty hydrocephalus requiring shunt placement. Twenty-six patients (13.4%) experienced postoperative infection. Sixteen patients (8.2%) had postoperative epileptic seizures. The identification of independent predictors of post-cranioplasty epidural hematomas requiring surgical evacuation will help identify at-risk patients, guide prophylactic care, and reduce morbidity of this common and important procedure.
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Affiliation(s)
- Aziz Bedioui
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
| | - Angela Elia
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Megan Still
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Oumaima Aboubakr
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
| | - Arthur Leclerc
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
- Department of Neurosurgery, Centre Hospitalier Universitaire Caen, Caen, France
| | - Martin Planet
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
| | - Giorgia Antonia Simboli
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Alessandro Moiraghi
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Houssem Fathallah
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
| | - Eduardo Parraga
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
| | - Chiara Benevello
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
| | - Edouard Dezamis
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
| | - Alexandre Roux
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Marc Zanello
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France
- Université Paris Cité, Paris, France
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, 1, rue Cabanis, 75674, Paris, France.
- Université Paris Cité, Paris, France.
- Inserm, U1266, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France.
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7
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Fokin AA, Wycech Knight J, Davis B, Stalder R, Mendes MAP, Darya M, Puente I. The timing and value of early postoperative computed tomography after head surgery in traumatic brain injury patients. Clin Neurol Neurosurg 2023; 226:107606. [PMID: 36706679 DOI: 10.1016/j.clineuro.2023.107606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/29/2022] [Accepted: 01/01/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To analyze the timing of the early postoperative computed tomography (CT) in traumatic brain injury (TBI) patients, and compare CT and neurological examination (NE) findings. METHODS Retrospective analysis included 353 TBI patients admitted to two level 1 trauma centers (2016-2020) who underwent head surgery and postoperative CT within 24 h. Analyzed variables: age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), Abbreviated Injury Scale head (AISh), comorbidities, CT and NE findings and timing, head surgery type, and mortality. RESULTS Patients mean age was 61.9 years, ISS 25.1, GCS 11.0, AISh 4.7. Postoperatively, mean time to first positive CT was 6.1 h and to first positive NE was 13.2 h. Positive CT alone was more accurate in identifying need for 2nd head surgery than positive NE alone (21.8 % vs 6.0 %, p = 0.04). There was no difference between patients with CT done earlier than 6 h compared to patients with CT done after 6 h in mortality (26.1 % vs 22.0 %, p = 0.4) or 2nd surgery rate (12.2 % vs 12.2 %, p = 1.0). Reversal of postoperative CT findings occurred in 1/6 of patients and was more common when CT was done earlier than 6 h compared to CT done later (25.7 % vs 0.8 %, p < 0.001). Early CT within 1 h rarely leads to the change of management but often is followed by another CT within 12 h. CONCLUSION In TBI patients postoperative CT was more effective than NE in predicting a need for 2nd head surgery. Postoperative head CT at 6 h is recommended to allow timely detection of intracranial deterioration, reduce the number of CTs and reversal findings as it does not increase 2nd surgery rates and mortality.
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Affiliation(s)
- Alexander A Fokin
- Delray Medical Center, Division of Trauma and Critical Care Services, 5352 Linton Boulevard, Delray Beach, FL 33484, USA; Florida Atlantic University, Charles E. Schmidt College of Medicine, Department of Surgery, 777 Glades Rd, Boca Raton, FL 33431, USA.
| | - Joanna Wycech Knight
- Delray Medical Center, Division of Trauma and Critical Care Services, 5352 Linton Boulevard, Delray Beach, FL 33484, USA; Broward Health Medical Center, Division of Trauma and Critical Care Services,1600 S Andrews Ave, Fort Lauderdale, FL 33316, USA
| | - Brooke Davis
- Broward Health Medical Center, Division of Trauma and Critical Care Services,1600 S Andrews Ave, Fort Lauderdale, FL 33316, USA
| | - Ryan Stalder
- Delray Medical Center, Division of Trauma and Critical Care Services, 5352 Linton Boulevard, Delray Beach, FL 33484, USA; Florida Atlantic University, Charles E. Schmidt College of Medicine, Department of Surgery, 777 Glades Rd, Boca Raton, FL 33431, USA
| | - Mary Anne P Mendes
- Delray Medical Center, Division of Trauma and Critical Care Services, 5352 Linton Boulevard, Delray Beach, FL 33484, USA; St.George's University, School of Medicine, University Centre Grenada, West Indies, Grenada
| | - Maral Darya
- Delray Medical Center, Division of Trauma and Critical Care Services, 5352 Linton Boulevard, Delray Beach, FL 33484, USA; Florida Atlantic University, Charles E. Schmidt College of Medicine, Department of Surgery, 777 Glades Rd, Boca Raton, FL 33431, USA
| | - Ivan Puente
- Delray Medical Center, Division of Trauma and Critical Care Services, 5352 Linton Boulevard, Delray Beach, FL 33484, USA; Florida Atlantic University, Charles E. Schmidt College of Medicine, Department of Surgery, 777 Glades Rd, Boca Raton, FL 33431, USA; Broward Health Medical Center, Division of Trauma and Critical Care Services,1600 S Andrews Ave, Fort Lauderdale, FL 33316, USA; Florida International University, Herbert Wertheim College of Medicine, Department of Surgery, 11200 SW 8th St, Miami, FL 33199, USA
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8
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Chen Q, Zhong X, Liu W, Wong C, He Q, Chen Y. Incidence of postoperative symptomatic spinal epidural hematoma requiring surgical evacuation: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3274-3285. [PMID: 36260132 DOI: 10.1007/s00586-022-07421-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/07/2022] [Accepted: 10/06/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE This systematic review and meta-analysis aimed to determine the incidence of symptomatic spinal epidural hematoma (SSEH) following spine surgery. METHODS We systematically searched for all relevant articles that mentioned the incidence of SSEH following the spine surgery published in the PubMed, Embase, and Cochrane Library databases through March 2022 and manually searched the reference lists of included studies. The Newcastle-Ottawa quality assessment scale (NOS) was used to assess the quality of the included studies. A fixed-effects or random-effects model was performed to calculate the pooled incidence of the totality and subgroups based on the heterogeneity. The potential publication bias was assessed by Egger's linear regression and a funnel plot. Sensitivity analysis was also conducted. RESULTS A total of 40 studies were included in our meta-analysis based on our inclusion and exclusion criteria. The overall pooled incidence of SSEH was 0.52% (95% CI 0.004-0.007). In the subgroup analysis, the pooled incidence of SSEH in males and females was 0.86% (95% CI 0.004-0.023) and 0.68% (95% CI 0.003-0.017). Among the different indications, a higher incidence (2.9%, 95% CI 0.006-0.084) was found in patients with deformity than degeneration (1.12%, 95% CI 0.006-0.020) and tumor (0.30%, 95% CI 0.006-0.084). For different surgical sites, the incidences of SSEH in cervical, thoracic and lumbar spine were 0.32% (95% CI 0.002-0.005), 0.84% (95% CI 0.004-0.017) and 0.63% (95% CI 0.004-0.010), respectively. The incidences of SSEH in anterior and posterior approach were 0.24% (95% CI 0.001-0.006) and 0.70% (95% CI 0.004-0.011), respectively. The pooled incidence of SSEH was five times higher with minimally invasive surgery (1.94%, 95% CI 0.009-0.043) than with open surgery (0.42%, 95% CI 0.003-0.006). Delayed onset of SSEH had a lower incidence of 0.16% (95% CI 0.001-0.002) than early onset. There were no significant variations in the incidence of SSEH between patients who received perioperative anticoagulation therapy and those who did not or did not report getting chemopreventive therapy (0.44%, 95% CI 0.006-0.084 versus 0.42%, 95% CI 0.003-0.006). CONCLUSION We evaluated the overall incidence proportion of SSEH after spine surgery and performed stratified analysis, including sex, surgical indication, site, approach, minimally invasive surgery, and delayed onset of SSEH. Our research would be helpful for patients to be accurately informed of their risk and for spinal surgeons to estimate the probability of SSEH after spine surgery.
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Affiliation(s)
- Qian Chen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, China
| | - Xiaoxin Zhong
- Department of Surgical Intensive Care Unit, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, China
| | - Wenzhou Liu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, China
| | - Chipiu Wong
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, China
| | - Qing He
- Department of Surgical Intensive Care Unit, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, China.
| | - Yantao Chen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107, Yanjiang West Road, Yuexiu District, Guangzhou, 510120, China.
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9
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Anaesthesia for neurosurgery. ANAESTHESIA & INTENSIVE CARE MEDICINE 2022. [DOI: 10.1016/j.mpaic.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Xu W, Guo J, Zhu J, Zhao X, Yasaman I, Chen J, Wang J, Fan S, Fang X. Delayed postoperative spinal epidural hematoma after anterior cervical discectomy and fusion: A case report. Front Surg 2022; 9:1005462. [PMID: 36225220 PMCID: PMC9549240 DOI: 10.3389/fsurg.2022.1005462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPostoperative spinal epidural hematoma (POSEH) causes rapid neurological deficits within 24 h following the operation and can be fatal. However, some POSEH symptoms manifest three days after the operation, also known as delayed POSEH (DPOSEH). Little attention has been provided upon DPOSEH owing to its rare incidence, resulting in serious consequences upon occurrence. To date, no cases of delayed POSEH after anterior cervical surgery have been reported.Case presentationWe describe a case of DPOSEH that presented with delayed neurological deficits on the fifth day after anterior cervical discectomy and fusion (ACDF) surgery. Methylprednisolone was administered but showed no efficacy. MR revealed low T1 and strip long T2 signals located behind discs. After emergency surgical decompression, the patient's muscle strength returned to the preoperative state. However, his muscle strength decreased again on the seventh postoperative day, and the patient's family refused further surgery. Nine months after ACDF, the patient died of septic shock and respiratory failure.ConclusionsDPOSEH can occur after three days or more following anterior cervical surgery; hence, monitoring of neurological function is suggested to be extended. Complete evaluation of risk factors, timely recognition, and differentiation of neurological symptoms are required for spine surgery. In the case of DPOSEH, methylprednisolone can be administered reasonably during the transition period. However, if there is no resolution of symptoms, emergency surgery should be performed as soon as possible.
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Affiliation(s)
- Wenbin Xu
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, China
| | - Jiandong Guo
- Department of Orthopaedics, Hangzhou Ninth People's Hospital, Hangzhou, China
| | - Jinjin Zhu
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, China
| | - Xing Zhao
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, China
| | | | - Jian Chen
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, China
| | - Jiying Wang
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, China
- Correspondence: Xiangqian Fang Shunwu Fan Jiying Wang
| | - Shunwu Fan
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, China
- Correspondence: Xiangqian Fang Shunwu Fan Jiying Wang
| | - Xiangqian Fang
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang, Hangzhou, China
- Correspondence: Xiangqian Fang Shunwu Fan Jiying Wang
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11
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Riviere-Cazaux C, Naylor RM, Van Gompel JJ. Ultra-early therapeutic anticoagulation after craniotomy - A single institution experience. J Clin Neurosci 2022; 100:46-51. [PMID: 35397255 DOI: 10.1016/j.jocn.2022.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 11/25/2022]
Abstract
There is a paucity of information regarding the optimal timing of initiation or re-initiation of therapeutic anticoagulation after intracranial surgery. Anticoagulation that is started too soon after surgery may increase the risk of catastrophic intracranial bleeding. However, there are scenarios that necessitate the use of anticoagulation in the immediate post-operative period despite the increased risk of hemorrhage. Therefore, we sought to report our experience with ultra-early therapeutic anticoagulation after craniotomy. Retrospective chart review of patients from a single institution between 1/1/2010 and 10/1/2021 who were treated with therapeutic anticoagulation for venous thromboembolism on or before 7-days after a craniotomy or craniectomy. The primary endpoint was intracranial hemorrhage resulting in death or return to the operating room for hematoma evacuation. Secondary endpoints included extra-cranial hemorrhage, length of hospital stay, and 90-day readmission rate. Eighteen patients were included for analysis. The median time that therapeutic anticoagulation was started was post-operative day 5 (range 1-7 days). One patient (5.6%) met the primary endpoint as they experienced an intracranial hemorrhage 5 days after starting anticoagulation, which required surgical evacuation. No patients experienced an extra-cranial hemorrhage. The median length of hospitalization was 13 days (range 4-89 days). No patients were readmitted within 90 days. The 90-day survival rate was 100%. Ultra-early anticoagulation after craniotomy resulted in a 5.6% risk of intracranial hemorrhage. Thus, ultra-early anticoagulation can be performed safely but it does carry a substantial risk of intracranial bleeding that may require emergent hematoma evacuation or result in permeant neurologic deficits or death.
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Affiliation(s)
| | - Ryan M Naylor
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Jamie J Van Gompel
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA; Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA.
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12
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Nakaya Y, Hayama S, Nakano A, Fujishiro T, Yano T, Usami Y, Mizutani M, Neo M. Usefulness of Percutaneous Ultrasonography for Deciding the Need of Surgical Evacuation of Epidural Hematoma After Cervical Double-door Laminoplasty. Clin Spine Surg 2022; 35:E216-E222. [PMID: 33979105 DOI: 10.1097/bsd.0000000000001189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 04/07/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE The objective of this study was to investigate the diagnostic utility of percutaneous ultrasonography (PUS) for postoperative epidural hematoma (EH) as a postoperative complication. SUMMARY OF BACKGROUND DATA We investigated the usefulness of PUS for determining the need of surgical evacuation of postoperative EH by comparing the postoperative magnetic resonance imaging (MRI) and PUS of the spinal cord. MATERIALS AND METHODS This study included patients who underwent cervical laminoplasty using suture anchors. Regular MRI and PUS were performed 1 week postoperatively. Whenever the patients exhibited neurological deterioration, MRI and PUS were performed. The spinal cord decompression status was classified into 3 grades using MRI and PUS. The existence of spinal pulsation was determined by PUS. RESULTS One hundred thirty-one patients were investigated. The decompression status by MRI and PUS, and the pulsation status by PUS showed a correlation with neurological deterioration (P<0.001). Four cases showed postoperative neurological deterioration and required revision surgery. The decompression status in these cases was classified as "poor" by both MRI and PUS, and as "no-pulsation" by PUS pulsation. The sensitivity and specificity for neurological deterioration was 100% and 95.1% in MRI decompression, 100% and 92.9% in PUS decompression, and 100% and 99.2% in PUS pulsation, respectively. CONCLUSIONS This is the first report that the disappearance of spinal pulsation was associated with neurological deterioration. PUS was useful in determining the need of surgical evacuation for postoperative EH. PUS should be the first choice of examination in the event of postoperative neurological deterioration following a cervical laminoplasty. When the disappearance of pulsation is confirmed, an additional hematoma evacuation surgery should be considered immediately without undertaking MRI. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yoshiharu Nakaya
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki-shi, Osaka Prefecture, Japan
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13
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Cai Y, Zhang T, Li G, Liu Z, Chen J, Liu K. Placement of Wound Drain After Anterior Circulation Aneurysm Clipping: A Single-Center Retrospective Study. World Neurosurg 2021; 155:e786-e791. [PMID: 34506981 DOI: 10.1016/j.wneu.2021.08.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Wound drain used to be a routine procedure after craniotomy for aneurysm clipping, although this was not based on clinical evidence. The purpose of our study was to determine the necessity of wound drain placement after anterior circulation aneurysm surgery. METHODS Retrospective analysis of patients with anterior circulation aneurysms treated by clipping in the Department of Neurosurgery, Wuhan University Zhongnan hospital from January 2019 to December 2019 was carried out. Demographic and clinical data, including age, sex, body mass index, disease history, results of the laboratory and imaging examinations, and surgical logs, were reviewed. RESULTS A total of 236 patients (90 male and 146 female) were included in the analysis and were divided into a Drain group and a No Drain group according to whether postoperative wound drainage was applied. There was no statistical difference in the incidence of a postoperative extradural hematoma between patients in the 2 groups. However, the incidence of postoperative meningitis was higher in the Drain group than in the No Drain group (9.09% vs. 1.59%, P = 0.009), and the total length of stay and postoperative length of stay in the Drain group were also more extended than in the No Drain group (17.32 ± 6.45 vs. 14.43 ± 5.75, P = 0.005; 12.83 ± 5.07 vs. 9.82 ± 4.50, P = 0.007, respectively). CONCLUSIONS Postoperative wound drain did not significantly reduce the incidence of an extradural hematoma after anterior circulation aneurysm surgery. On the contrary, it may be associated with an increased incidence of postoperative meningitis and length of stay. Given these findings, the postoperative drain should be maintained cautiously and meet more rigorous application criteria.
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Affiliation(s)
- Yuankun Cai
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, P.R. China
| | - Tingbao Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, P.R. China
| | - Guo Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, P.R. China
| | - Zheng Liu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, P.R. China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, P.R. China.
| | - Kui Liu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, P.R. China
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Efficacy of an opioid-sparing analgesic protocol in pain control after less invasive cranial neurosurgery. Pain Rep 2021; 6:e948. [PMID: 34368598 PMCID: PMC8341305 DOI: 10.1097/pr9.0000000000000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/15/2021] [Accepted: 05/22/2021] [Indexed: 12/04/2022] Open
Abstract
An opioid-sparing protocol for postoperative pain management in less invasive cranial neurosurgery significantly lowered opioid usage while reducing pain scores. Introduction: Opioid overuse in postoperative patients is a worrisome trend, and potential alternatives exist which warrant investigation. Nonsteroidal anti-inflammatory drug use in treating postoperative cranial surgery pain has been hampered by concern for inadequate pain control and increased risk of hemorrhagic complications. A safe and effective alternative to opioid-based pain management is critical to improving postoperative care. Objective: The objective of this retrospective study was to determine whether an NSAID-based opioid-sparing pain management protocol (OSP) is effective in analgesic control of less invasive cranial surgery patients at 6-, 12-, and 24-hour postoperatively. Secondary aims included investigating differences in hemorrhagic complications. Methods: Five hundred sixty-six consecutive patients who underwent cranial surgery before and after implementation of the celecoxib-based OSP were eligible. Propensity score matching was used to match patients in each cohort. Results: The opioid-sparing cohort had lower pain scores at 6 hours (3.45 vs 4.19, P = 0.036), 12 hours (3.21 vs 4.00, P = 0.006), and 24 hours (2.90 vs 3.59, P = 0.010). Rates of postoperative hemorrhage were not significantly different (5% intervention vs 8% control, P = 0.527). The opioid-sparing pain management protocol provided comparable or better pain control in the first 24 hours after less invasive cranial surgery. Hemorrhage rates did not change with the use of an NSAID-based OSP. Conclusion: An effective alternative to the current standard opioid-based pain management is feasible for less invasive cranial surgery. Determinations of hemorrhage risk and more complex cranial surgery will require larger prospective randomized trials.
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15
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Eroglu U, Zaimoğlu M, Sayacı EY, Ugur HC, Attar A, Kahilogullari G, Bozkurt M, Ünlü MA, Özgüral O, Doğan İ, Seçinti KD, Abbasoğlu B, Erdoğan K, Gökalp E, Yakar F, Çağlar YŞ, Cohen-Gadol A. Is Placing Prophylactic Dural Tenting Sutures a Dogma? World Neurosurg 2021; 153:e403-e407. [PMID: 34224886 DOI: 10.1016/j.wneu.2021.06.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In this study, we investigated if and when dural tenting sutures are necessary during craniotomy. METHODS Results from 437 patients 18-91 years of age (average, 43.5 years) who underwent supratentorial craniotomy between 2014 and 2019 were evaluated. The patients were categorized into 1 of 3 groups: patients who had at least 3 prophylactic dural tenting sutures placed before opening of the dura (group 1); patients who had at least 3 dural tenting sutures placed after surgery was completed, during closure (group 2); or patients who had no dural tenting sutures (group 3 [control]). All such sutures in groups 1 and 2 were placed in the circumference of the craniotomy and dural junction. No central dural tenting sutures were placed in any of the patients. RESULTS Among the 437 patients, 344 underwent surgery for the first time and 93 were undergoing a second surgery. Cranial computed tomography imaging was performed for each patient 1 hour, 3 days, and 1 month after surgery. In group 1, 3 patients had a cerebral cortex contusion and 2 patients had acute subdural hematoma after the sutures were placed. In groups 2 and 3, none of the patients had a cerebral cortex contusion or acute subdural hematoma. Fewer complications were observed when dural tenting sutures were placed during postsurgical closure. CONCLUSIONS Placing dural tenting sutures is an important technique for ensuring hemostasis. However, when not needed, they seem to cause inadvertent complications. As our results suggest, knowing when and where to use them is equally important.
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Affiliation(s)
- Umit Eroglu
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Murat Zaimoğlu
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Emre Yağız Sayacı
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Hasan Caglar Ugur
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Ayhan Attar
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Gokmen Kahilogullari
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Melih Bozkurt
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Mustafa Ağahan Ünlü
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Onur Özgüral
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - İhsan Doğan
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Kutsal Devrim Seçinti
- Faculty of Medicine, Department of Neurosurgery, Kahramanmaraş Sütçü İmam University, Maras, Turkey
| | - Bilal Abbasoğlu
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Koral Erdoğan
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Elif Gökalp
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Fatih Yakar
- Faculty of Medicine, Department of Neurosurgery, Pamukkale University, Denizli, Turkey
| | - Yusuf Şükrü Çağlar
- Faculty of Medicine, Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Aaron Cohen-Gadol
- The Neurosurgical Atlas, Carmel, Indiana, USA; Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Park JH, Park S, Choi SA. Incidence and risk factors of spinal epidural hemorrhage after spine surgery: a cross-sectional retrospective analysis of a national database. BMC Musculoskelet Disord 2020; 21:324. [PMID: 32450822 PMCID: PMC7249427 DOI: 10.1186/s12891-020-03337-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/08/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND With increasing number of patients undergoing spine surgery, the spinal epidural hemorrhage (SEH) has become a growing concern. However, current studies on SEH rely on case reports or observations from a single center. Our study attempted to demonstrate the incidence rate and risk factors of SEH using a national dataset. METHODS A total of 17,549 spine surgery cases from the Health Insurance Review and Assessment Service National Inpatient Sample of 2014 were analyzed. After evaluating the incidence of SEH based on severe cases requiring reoperation, a univariate comparison was performed. Variables found to be significant were included in a multivariable analysis model to determine the risk factors. RESULTS The incidence of SEH was found to be 1.15% in Korean population, and there were no severe SEH cases. Our analysis confirmed the previous findings that lumbar surgery, intraoperative blood loss, prolonged surgical time, high blood pressure, use of nonsteroidal anti-inflammatory drugs, and concurrent bleeding factors are the risk factors of SEH. Anterior approach showed a protective effect. The use of anticoagulant demonstrated no statistical significance. CONCLUSION Although severe SEH cases were not detected, the incidence of SEH was similar to that reported in literature. Given that SEH is a rare complication of spine surgery and constitutes an important research area that needs to be studied further, our study makes a meaningful contribution based on a rigorous national level sample for the first time and provides the academic circle and health professionals with a reliable evidence of improved clinical outcomes in such cases.
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Affiliation(s)
- Ji Hyun Park
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong-si, 30019 South Korea
| | - Sunny Park
- Research Institute of Pharmaceutical Sciences and Technology, Korea University College of Pharmacy, 2511 Sejong-ro, Sejong-si, 30019 South Korea
| | - Soo An Choi
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong-si, 30019 South Korea
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Restarting Therapeutic Anticoagulation After Elective Craniotomy for Patients with Chronic Atrial Fibrillation: A Review of the Literature. World Neurosurg 2020; 137:130-136. [PMID: 32036067 DOI: 10.1016/j.wneu.2020.01.235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/21/2022]
Abstract
The decision to restart systemic anticoagulation after surgery requires a nuanced risk-benefit analysis. The potential for surgical site bleeding must be balanced against the risk of thromboembolic events. In the context of postoperative neurosurgical patients, the consequences of either hemorrhage or thromboembolism can be devastating. However, few studies to date have attempted to determine the optimal time to resume anticoagulation after craniotomy. As a result, the decision of when to restart anticoagulation remains largely subjective and highly variable between surgeons and institutions. In this study, we aim to develop an algorithm that incorporates existing metrics and expert opinion toward the goal of developing guidelines for restarting anticoagulation after elective craniotomy.
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Figueroa J, Morell A, Bowory V, Shah AH, Eichberg D, Buttrick SS, Richardson A, Sarkiss C, Ivan ME, Komotar RJ. Minimally invasive keyhole temporal lobectomy approach for supramaximal glioma resection: A safety and feasibility study. J Clin Neurosci 2020; 72:57-62. [PMID: 31948883 DOI: 10.1016/j.jocn.2020.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/05/2020] [Indexed: 10/25/2022]
Abstract
With a recent trend towards supra-maximal resection for gliomas and minimally invasive techniques, keyhole temporal lobectomies may serve an important role in neurosurgical oncology. Due to their location and proximity to eloquent brain, temporal lobe gliomas offer unique challenges that may limit the extent of resection. Here we describe a modified technique using mini-craniotomies through a keyhole approach for temporal lobectomies in glioma patients. We retrospectively reviewed data from consecutive patients who underwent temporal lobectomies for resection of gliomas from 2012 to 2018. Demographic data, extent of tumor resection, pre and post-op KPS, short term and long term complications, as well as other relevant data were collected. We identified 57 patients who underwent keyhole-mini craniotomy for temporal lobectomies for glioma. Surgical procedures were performed in 12 patients for low-grade glioma (LGG) and 45 patients for high-grade glioma (HGG). Awake craniotomies were performed in 15 of the cases, and 13 cases were for tumor recurrence. Supra-maximal resection (SMR) was achieved in 15 patients, while gross total resection (GTR) and near total resection (NTR) achieved in 32 patients and 10 patients, respectively. Average pre- and post-op KPS were equivalent, and post-operative complications requiring surgical intervention were experienced in 4 patients. Here we show that our modified keyhole craniotomy is both safe and effective in achieving SMR or GTR in glioma patients, with minimal morbidity. This minimally-invasive temporal lobectomy may be an instrumental tool for neurosurgical oncologists transitioning to less invasive techniques.
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Affiliation(s)
- Javier Figueroa
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States.
| | - Alexis Morell
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Veronica Bowory
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Daniel Eichberg
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Simon S Buttrick
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Angela Richardson
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Christopher Sarkiss
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of MedicineLois Pope Life Center, 1095 NW 14th Terrace, Miami, FL 33136, United States
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Liao Y, Tian Y, Ye R, Tang C, Tang Q, Ma F, Yang S, He H, Zhong D. Risk and treatment of symptomatic epidural hematoma after anterior cervical spine surgery: A retrospective clinical study. Medicine (Baltimore) 2020; 99:e18711. [PMID: 31914081 PMCID: PMC6959927 DOI: 10.1097/md.0000000000018711] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Symptomatic epidural hematoma (SEH) after anterior cervical spine surgery is very rare, but it has disastrous consequences for the patients. Timely diagnosis and evaluation can effectively reduce the sequelae of neurological deficit in SEH. The purpose of this study was to retrospectively analyze a subset of clinical data of SEH after anterior cervical spine surgery, and to investigate the risk factors and treatment experience of this serious complication.Neurological deterioration after anterior cervical spine surgery was detected in six patients. Epidural hematoma was confirmed by emergency cervical magnetic resonance imaging (MRI). The patients included five males and one female, with an average age of 56.7 ± 13.1 years (range 42-76 years). Three patients had a history of drinking and/or smoking. All of the patients were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) preoperatively, but without anticoagulant drugs or pre-spinal surgery. The coagulation function was normal in all patients. Except for one patient, who had lower blood pressure (BP) during the operation and higher BP after the operation, the other patients had a normal level of BP during the pre-, intra-, and post-operation periods. The average time was 9.9 ± 6.7 hours (range, 2-19 hours) from the postoperative period to the initial neurological deficit and 6.3 ± 6.0 hours (range, 1.8-16.7 hours) from the initial deterioration to evacuation. Five patients underwent emergency evacuation, and one patient underwent conservative treatment. Four patients who underwent evacuation and one patient who received conservative treatment achieved neurological function recovery with an American Spinal Injury Association (ASIA) grade 2.4 ± 0.9 (range, 2-4 score) score at the last follow-up. One patient with confirmed arterial epidural hemorrhage during the evaluation showed no neurological function recovery at the last follow-up.Wide exposure of the epidural space and BP level during the perioperative period play an important role in the formation of SEH after anterior cervical spine surgery. Arterial epidural hematoma has serious consequences; therefore, early diagnosis and evaluation play an important role in the recovery from paralysis.
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Affiliation(s)
| | | | - Rupei Ye
- Department of Pathology, The affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | | | | | - Fei Ma
- Department of Spinal Surgery
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Symptomatic postoperative spinal epidural hematoma after spine tumor surgery: Incidence, clinical features, and risk factors. Spinal Cord 2019; 57:708-713. [DOI: 10.1038/s41393-019-0281-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 01/09/2023]
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21
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Khalili H, Ghaffarpasand F, Niakan A, Golestani N, Ahrari I, Abbasi HR, Rasti A. Determinants of reoperation after decompressive craniectomy in patients with traumatic brain injury: A comparative study. Clin Neurol Neurosurg 2019; 181:1-6. [PMID: 30954701 DOI: 10.1016/j.clineuro.2019.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/25/2019] [Accepted: 03/31/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Reoperation after decompressive craniectomy (DC) in patients with traumatic brain injury (TBI) remains a dilemma and the risk factors are to be identified. The aim of the current study was to determine the determinants and risk factors of reoperation after DC in patients with TBI. PATIENTS AND METHODS This retrospective case-controlled study was conducted during a 4-year period from September 2013 to October 2017 in a level I trauma center affiliated with Shiraz University of Medical Sciences in southern Iran. We included all the adult (≥18 years) patients with TBI who underwent primary or secondary DC in our center during the study period. Those who underwent reoperation were compared to those who underwent DC only regarding the demographic findings, clinical features and neuroimaging findings. A univariate and multivariate logistic regression analysis was performed to determine the determining factors of reoperation. RESULTS Overall we included 371 patients with mean age of 36.45 ± 14.18 years. Among the patients there were 325 (87.6%) men and 46 (12.4%) women. The reoperation in patients undergoing DC due to TBI was associated with primary DC (p = 0.039) and higher Marshall grade (p = 0.027). Those who underwent reoperation after DC for TBI had significantly higher ICU (p = 0.007) and hospital LOS (p = 0.001) and lower 6-month GOSE (p = 0.010). Age (p < 0.001), GCS (p < 0.001) and pupils (p = 0.027) were predictors of outcome in reoperation group. Reoperation in primary DC group was associated with pupil reactivity (p = 0.002) and number of episodes with INR above 1.5 (p = 0.037) Conclusion: Reoperation after DC for TBI is associated with primary DC, and Marshall grade. The reoperation after DC is associated with worse outcome and longer ICU and hospital stay. The age, GCS and pupil reactivity are the main predictors of outcome in those with reoperation after DC for TBI.
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Affiliation(s)
- Hosseinali Khalili
- Trauma Research Center, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Fariborz Ghaffarpasand
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran.
| | - Amin Niakan
- Trauma Research Center, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Nasim Golestani
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Iman Ahrari
- Student Research Committee, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hamid Reza Abbasi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ali Rasti
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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22
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The Incidence, Clinical Features, and a Comparison Between Early and Delayed Onset of Postoperative Spinal Epidural Hematoma. Spine (Phila Pa 1976) 2019; 44:420-423. [PMID: 30095797 DOI: 10.1097/brs.0000000000002838] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective observational study. OBJECTIVE To investigate the incidence and clinical features of symptomatic postoperative spinal epidural hematoma (PSEH) with regard to spinal level and to compare early and delayed onset cases. SUMMARY OF BACKGROUND DATA PSEH is a serious complication of spinal surgeries. The difference in clinical manifestations between early and delayed PSEH remains unclear. METHODS Patients who underwent spinal surgeries between 1999 and 2013 at our institution, were reviewed through their medical records. For patients with PSEH, the incidence, duration to onset, duration from onset to evacuation, symptoms, recovery rate (American Spinal Injury Association grade), neurological outcomes, comorbidities, and preoperative use of anticoagulant drugs were examined. We next compared patients with early onset PSEH (onset until day 3) versus delayed onset (onset day 4 or later) regarding these clinical factors. RESULTS Fourteen patients (0.42%, 14/3371) developed symptomatic PSEH. Initial symptoms were observed between 0 and 7 days (mean 2.6 ± 2.4 d) and almost half (43%, 6/14) occurred during the delayed phase (mean 5.0 ± 1.1 d postsurgery). Paralysis was the predominant symptom in patients with cervical and thoracic surgeries (100%, 6/6), whereas severe pain was most frequent in patients with lumbar procedures (63%, 5/8) (P = 0.019). No significant differences were identified between early and delayed groups. Neurological outcome was good in 10 cases, partial in two cases, and poor in two cases. CONCLUSION The frequency was consistent in every spinal region, and the symptoms due to PSEH were correlated with spinal level. Almost half the cases were diagnosed after a delay (day 4 or later), which supports the necessity to follow up patients with spinal surgeries more carefully for a week or so and to educate patients and comedical staff about the possibility of delayed hematoma disorders in order not to defer timely intervention. LEVEL OF EVIDENCE 4.
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23
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Lubnin AY. [Current trends in the development of neuroanesthesiology]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2019; 83:83-91. [PMID: 31825379 DOI: 10.17116/neiro20198305183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The paper presents the author's analysis of the main trends in the development of modern neuroanesthesiology over the past five to ten years. These, in the author\s opinion, include the introduction and elaboration of blood-sparing techniques, monitoring the depth of anesthesia, fast track concept, applying regional (conduction) anesthesia techniques, xenon anesthesia, development of effective and safe protocols for DVT and PTE prophylaxis for neurosurgical patients, study of the hemostatic system using bedside methods for assessing hemostasis (thromboelastogram) and correcting hypocoagulation by activated recombinant VII factor.
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Affiliation(s)
- A Yu Lubnin
- Burdenko Neurosurgical Center, Moscow, Russia
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24
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Cranioplasty following decompressive craniectomy: minor surgical complexity but still high periprocedural complication rates. Neurosurg Rev 2018; 43:217-222. [PMID: 30293162 DOI: 10.1007/s10143-018-1038-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
Cranioplasty following decompressive craniectomy is of low surgical complexity, so much so that it has become the "beginners" cranial case. However, these "simple" procedures may have high complication rates. Identification of specific risk factors would allow targeted intervention to lower the complication rates. The aim of this study was to assess the rate of complications and to evaluate potential risk factors. We conducted a review of all patients who underwent cranioplasty in our center following decompressive craniectomy for stroke or brain trauma between 2009 and 2016. One hundred fifty-two patients were identified. Fifty-three percent were male. Mean age was 48 (range 11-78). Median time from craniectomy until cranioplasty was 102 days (range 14-378). The overall rate of complications, such as postoperative bleeding, seizures, postoperative infection, and hydrocephalus, was 30%. The mortality rate was 1%. None of the following potential risk factors was associated with significantly increased risk of periprocedural complications: gender (p = 0.34), age (p = 0.39), cause of initial surgery (p = 0.08), duration of surgery (p = 0.59), time of surgery (0.24), surgical experience (p = 0.17), and time from craniectomy until cranioplasty (p = 0.27). The 30-day complication rate following cranioplasty is high, but serious permanent deficits from these complications were rare. We found no clear predictor for these 30-day complications, which renders its prevention difficult.
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Wang J, Xu Y, Liu R, Huang M, Yan X, Lu J, Meng X, Zhan R. Analysis of Unplanned Return to the Operating Room Within 30 Days of Initial Neurosurgery: A 3-Year Experience at a Single Center. World Neurosurg 2018; 118:e766-e771. [PMID: 30026146 DOI: 10.1016/j.wneu.2018.07.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the reasons and prognosis of unplanned return to the operating room (URTOR) and to help improve neurosurgical service quality. METHODS Medical records of URTOR within 30 days of initial surgery were reviewed at a single neurosurgical center for a period of 3 years. Out of 4516 neurosurgeries, 62 URTOR cases were included to analyze patients' age, sex, initial surgery code, seniority of the performed surgeon, interval between the reopening procedures and initial procedures, reason for reopening, prognosis, and complications. RESULTS The 62 patients underwent 70 URTORs. Out of 1445 primary operations performed by junior surgeons, 40 experienced URTOR, whereas 22 of 3071 craniotomies initially performed by senior surgeons resulted in URTOR. Five patients died in this series. Out of the 54 patients who experienced 1-time URTOR, 3 died, whereas 2 of the 8 patients who experienced 2-time URTOR died. Of 22 URTOR surgeries performed by senior surgeons, 10 took place within 24 hours, compared with 26 out of 48 performed by the junior surgeon. CONCLUSIONS The main reasons for URTOR after neurosurgery were rebleeding and swelling of the brain. The number of URTORs and time from primary craniotomy to URTOR are not associated with morbidity or mortality. However, the seniority of the surgeon affects the rate of URTOR: surgeons with rich experience in surgery may reduce the chance of a second craniotomy and increase the chance of a good prognosis.
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Affiliation(s)
- Jianjun Wang
- Department of Neurosurgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Ying Xu
- Department of Hepatobiliary Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Rengli Liu
- Department of Neurosurgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Meiying Huang
- Department of Neurosurgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Xin Yan
- Department of Neurosurgery, Laicheng District People's Hospital, Laiwu, Shandong, China
| | - Jie Lu
- Department of Neurosurgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Xiangjing Meng
- Department of Neurosurgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Rucai Zhan
- Department of Neurosurgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China.
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"Wounded Meningioma Syndrome": Postoperative Exacerbation of Brain Edema in Brain-Invasive Meningioma. World Neurosurg 2018; 115:483-484. [PMID: 29958375 DOI: 10.1016/j.wneu.2018.03.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 11/21/2022]
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