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Pedro T, Prisco I, Albuquerque L, Vaz R, Silva PA. The distance between the falx cerebri and the corpus callosum in patients with bilateral subdural hematomas: A potential measure of disease severity. Clin Neurol Neurosurg 2024; 236:108090. [PMID: 38160657 DOI: 10.1016/j.clineuro.2023.108090] [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: 10/05/2023] [Revised: 10/27/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND We aimed to assess the usefulness of the falx cerebri and the corpus callosum measurements as imaging markers of the evaluation of patients with bilateral subdural hematomas. METHODS The anterior-posterior and craniocaudal distances between the falx cerebri (FC) and the corpus callosum (CC) were retrospectively measured in 88 head CT scans from 2018 to 2022 from patients with bilateral subdural hematomas and associated with quantitative data and clinical outcomes. Statistical analysis was performed using multivariate regression and receiver operating characteristic curves. RESULTS Of the 88 patients included, 77.3% were male and the median age of 76.0 years (interquartile range 14.0). The mean craniocaudal and anterior-posterior FC-CC distances were 27.6 ± 6.2 mm and 25.1 ± 6.9 mm, respectively, and showed a positive correlation with hematoma thickness and volume. Both anterior-posterior and craniocaudal FC-CC distances exhibited moderate to good inter-rater reliability. After adjusting for confounders, the craniocaudal FC-CC distance was associated with an increased risk of altered consciousness at admission (OR=1.013; 95% CI 1.001-1.024; p = 0.031), downward displacement of the third ventricle (OR=1.019; 95% CI 1.001-1.038; p = 0.035), and a reduced time to surgery (β = 0.057; 95% CI 0.007-0.107; p = 0.027). CONCLUSION This study emphasizes that increased FC-CC distances in patients with bilateral subdural hematomas may aid clinical decision-making and are associated with larger hematoma volumes, evidence of descending transtentorial herniation on imaging, and a heightened risk of altered consciousness at admission.
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Affiliation(s)
- Tiago Pedro
- Department of Neuroradiology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.
| | - Inês Prisco
- Department of Neuroradiology, Unidade Local de Saúde de Matosinhos, E.P.E., Porto, Portugal
| | - Luís Albuquerque
- Department of Neuroradiology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Rui Vaz
- Department of Neurosurgery, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal
| | - Pedro Alberto Silva
- Department of Neurosurgery, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Portugal
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Ellens NR, Susa S, Hoang R, Love T, Jones J, Santangelo G, Bender MT, Mattingly TK. Comparing Outcomes for Emergent Cranial Neurosurgical Procedures Performed "During Hours" and "After Hours". World Neurosurg 2024; 181:e703-e712. [PMID: 37898280 DOI: 10.1016/j.wneu.2023.10.116] [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: 06/19/2023] [Revised: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE Surgery performed at night and on weekends is thought to be associated with increased complications. However, the impact of time of day on outcomes has not been studied within cranial neurosurgery. We aim to determine if there are differences in outcomes for cranial neurosurgery performed after hours (AH) compared with during hours (DH). METHODS We performed a single-center retrospective study of cranial neurosurgery patients who underwent emergent surgery from January 2015 through December 2019. Surgery was considered DH if the incision occurred between 8 am and 5 pm Monday through Friday. We assessed outcome measures for differences between operations performed DH or AH. RESULTS Three-hundred and ninety-three patients (114 DH, 279 AH) underwent surgery. There was a lower rate of return to the operating room within 30 days for AH (8.6%) compared with DH (14.0%), P = 0.03, on multivariate analysis. There were no significant differences in length of operation, estimated blood loss, improvement in Glasgow Coma Scale, intensive care unit and total hospital length of stay, 30-day readmission, 30-day mortality, and in-hospital mortality for cases performed DH compared with AH. Further subgroup analyses were performed for patients who underwent immediate surgery for subdural hematomas, with no differences noted in outcomes on multivariate analysis. CONCLUSIONS This study suggests that operating AH does not appear to negatively impact outcomes when compared with operating DH, in cases of cranial neurosurgical emergencies. Further study assessing the impact on elective neurosurgical cases is required.
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Affiliation(s)
- Nathaniel R Ellens
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA.
| | - Stephen Susa
- University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
| | - Ricky Hoang
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York, USA
| | - Tanzy Love
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Jeremiah Jones
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | | | - Matthew T Bender
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA
| | - Thomas K Mattingly
- Department of Neurosurgery, University of Rochester, Rochester, New York, USA
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Kim KH, Ro YS, Park JH, Jeong J, Shin SD, Moon S. Association between time to emergency neurosurgery and clinical outcomes for spontaneous hemorrhagic stroke: A nationwide observational study. PLoS One 2022; 17:e0267856. [PMID: 35482789 PMCID: PMC9049323 DOI: 10.1371/journal.pone.0267856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/16/2022] [Indexed: 11/19/2022] Open
Abstract
Objective
Spontaneous hemorrhagic stroke is a devastating disease with high mortality and grave neurological outcomes worldwide. This study aimed to evaluate the association between the elapsed time from emergency department (ED) visit to emergency neurosurgery and clinical outcomes in patients with spontaneous hemorrhagic stroke.
Methods
A nationwide cross-sectional study was conducted using the nationwide emergency database in Korea. Spontaneous hemorrhagic stroke patients who received neurosurgery within 12 hours of ED visit between January 2018 and December 2019 were enrolled. The main exposure was time to neurosurgery and the primary outcome was in-hospital mortality. Multivariable logistic regression was conducted.
Results
Among 2,602 study populations (incidence rate: 2.5 per 100,000 person-years, 15.8% of SAH, 78.6% of ICH, and 5.6% of mixed type), 525 (20.2%) patients received surgery in the ultra-early (0–2 hours) group, 1,093 (42.0%) in the early (2–4 hours) group, and 984 (37.8%) in the late (4–12 hours) group. The early group showed better survival outcomes than the ultra-early and late group (in-hospital mortality 22.2% vs. 26.5% and 26.1%, p = 0.06). Compared to the late group, adjusted OR (95% CI) for in-hospital mortality was 0.78 (0.63–0.96) for the early group, while there was no significant difference in the ultra-early group (0.90 (0.69–1.16)).
Conclusions
Early neurosurgery within 2–4 hours of the ED visit was associated with favorable survival outcomes in patients with spontaneous hemorrhagic stroke.
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Affiliation(s)
- Ki Hong Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- * E-mail:
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Joo Jeong
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Sungwoo Moon
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Korea University Ansan Hospital, Gyeonggi, Korea
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Khattar NK, McCallum AP, Fortuny EM, White AC, Ball TJ, Adams SW, Meyer KS, Wei G, John KD, Bak E, Sieg EP, Ding D, James RF. Minimally Invasive Endoscopy for Acute Subdural Hematomas: A Report of 3 Cases. Oper Neurosurg (Hagerstown) 2021; 20:310-316. [PMID: 33372226 DOI: 10.1093/ons/opaa390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 09/16/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Acute subdural hematomas (aSDHs) occur in approximately 10% to 20% of all closed head injury and represent a significant cause of morbidity and mortality in traumatic brain injury patients. Conventional craniotomy is an invasive intervention with the potential for excess blood loss and prolonged postoperative recovery time. OBJECTIVE To evaluate the outcomes of minimally invasive endoscopy for evacuation of aSDHs in a pilot feasibility study. METHODS We retrospectively reviewed the records of consecutive patients with aSDHs who underwent surgical treatment at our institution with minimally invasive endoscopy using the Apollo/Artemis Neuro Evacuation Device (Penumbra, Alameda, California) between April 2015 and July 2018. RESULTS The study cohort comprised three patients. The Glasgow Coma Scale on admission was 15 for all 3 patients, median preoperative hematoma volume was 49.5 cm3 (range 44-67.8 cm3), median postoperative degree of hematoma evacuation was 88% (range 84%-89%), and median modified Rankin Scale at discharge was 1 (range 0-3). CONCLUSION Endoscopic evacuation of aSDHs can be a safe and effective alternative to craniotomy in appropriately selected patients. Further studies are needed to refine the selection criteria for endoscopic aSDH evacuation and evaluate its long-term outcomes.
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Affiliation(s)
- Nicolas K Khattar
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Abigail P McCallum
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Enzo M Fortuny
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Andrew C White
- Department of Radiology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Tyler J Ball
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Shawn W Adams
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Kimberly S Meyer
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - George Wei
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Kevin D John
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Esther Bak
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Emily P Sieg
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Dale Ding
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Robert F James
- Department of Neurological Surgery, Indiana University School of Medicine, IU Health Physicians Neurosurgery, Indianapolis, Indiana
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KIYOHIRA M, SUEHIRO E, SHINOYAMA M, FUJIYAMA Y, HAJI K, SUZUKI M. Combined Strategy of Burr Hole Surgery and Elective Craniotomy under Intracranial Pressure Monitoring for Severe Acute Subdural Hematoma. Neurol Med Chir (Tokyo) 2021; 61:253-259. [PMID: 33597319 PMCID: PMC8048118 DOI: 10.2176/nmc.oa.2020-0266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/25/2020] [Indexed: 11/24/2022] Open
Abstract
Burr hole surgery in the emergency room can be lifesaving for patients with acute subdural hematoma (ASDH). In the first part of this study, a strategy of combined burr hole surgery, a period of intracranial pressure (ICP) monitoring, and then craniotomy was examined for safe and effective treatment of ASDH. Since 2012, 16 patients with severe ASDH with indications for burr hole surgery were admitted to Kenwakai Otemachi Hospital. From 2012 to 2016, craniotomy was performed immediately after burr hole surgery (emergency [EM] group, n = 10). From 2017, an ICP sensor was placed before burr hole surgery. After a period for correction of traumatic coagulopathy, craniotomy was performed when ICP increased (elective [EL] group, n = 6). Patient background, bleeding tendency, intraoperative blood transfusion, and outcomes were compared between the groups. In the second part of the study, ICP was measured before and after burr hole surgery in seven patients (including two of the six in the EL group) to assess the effect of this surgery. Activated partial thromboplastin time (APTT) and prothrombin time-international normalized ratio (PT-INR) were significantly prolonged after craniotomy in the EM group, but not in the EL group, and the EM group tended to require a higher intraoperative transfusion volume. The rate of good outcomes was significantly higher in the EL group, and ICP was significantly decreased after burr hole surgery. These results suggest the value of burr hole surgery followed by ICP monitoring in patients with severe ASDH. Craniotomy can be performed safely using this method, and this may contribute to improved outcomes.
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Affiliation(s)
- Miwa KIYOHIRA
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Eiichi SUEHIRO
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Chiba, Japan
| | - Mizuya SHINOYAMA
- Department of Neurosurgery, Kenwakai Otemachi Hospital, Kitakyushu, Fukuoka, Japan
| | - Yuichi FUJIYAMA
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
- Department of Neurosurgery, Shinyurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Kohei HAJI
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Michiyasu SUZUKI
- Department of Neurosurgery, Shinyurigaoka General Hospital, Kawasaki, Kanagawa, Japan
- Department of Advanced ThermoNeuroBiology, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
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Barro B, Kobner S, Ansari A. Decompression of Subdural Hematomas Using an Intraosseous Needle in the Emergency Department: A Case Series. Clin Pract Cases Emerg Med 2020; 4:312-315. [PMID: 32926674 PMCID: PMC7434269 DOI: 10.5811/cpcem.2020.6.46069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Traumatic subdural hematomas beget significant morbidity and mortality if not rapidly decompressed. This presents a unique challenge to the emergency physician without immediate neurosurgical support. Case Report We report two cases of patients in Los Angeles County with traumatic subdural hematomas and clinical deterioration in the emergency department (ED) who were treated with decompression using an intraosseous needle drill. Discussion We believe these cases represent the first use of this technique to temporize a subdural hematoma in the ED.
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Affiliation(s)
- Brett Barro
- LAC+USC Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Scott Kobner
- LAC+USC Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Ashkon Ansari
- Keck School of Medicine of USC, Department of Emergency Medicine, Los Angeles, California; Antelope Valley Hospital, Department of Emergency Medicine, Lancaster, California
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Chrastina J, Šilar Č, Zeman T, Svoboda M, Krajsa J, Musilová B, Novák Z. Reoperations after surgery for acute subdural hematoma: reasons, risk factors, and effects. Eur J Trauma Emerg Surg 2019; 46:347-355. [DOI: 10.1007/s00068-019-01077-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 01/18/2019] [Indexed: 11/30/2022]
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