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Guo C, Zhang X, Hu Z, Guo K, Li Z, Li J, Peng J. Middle Meningeal Artery Embolization Combined With Endoscopic Treatment for Chronic Subdural Hematoma. J Craniofac Surg 2023; 34:2529-2532. [PMID: 37665073 DOI: 10.1097/scs.0000000000009715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE To explore the clinical feasibility of middle meningeal artery (MMA) embolization combined with endoscopic treatment for new or recurrent chronic subdural hematoma (CSDH). METHODS Twenty patients with CSDH treated in the Binzhou Medical University Hospital from June 2020 to October 2022 were analyzed retrospectively. The clinical information, prognosis, imaging results, and surgical results of the patients were collected and analyzed. The authors first performed MMA embolization, and then endoscopic treatment of CSDH was performed after successful embolization of MMA. Results: All 20 patients with CSDH were successfully treated with MMA embolization combined with endoscope-assisted evacuation. The symptoms of all patients were relieved, no surgical complications occurred, and no rebleeding and recurrence were found in follow-up computed tomography. CONCLUSION Middle meningeal artery embolization combined with endoscopic treatment of CSDH has a good clinical effect, and it may prevent postoperative recurrence.
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Affiliation(s)
- Chong Guo
- Department of Neurosurgery, Binzhou Medical University Hospital
| | - Xinfan Zhang
- Department of Neurosurgery, Binzhou People's Hospital, Binzhou, Shandong, China
| | - Zhongbo Hu
- Department of Neurosurgery, Binzhou Medical University Hospital
| | - Ke Guo
- Department of Neurosurgery, Binzhou Medical University Hospital
| | - Zefu Li
- Department of Neurosurgery, Binzhou Medical University Hospital
| | - Jianmin Li
- Department of Neurosurgery, Binzhou Medical University Hospital
| | - Jiangtao Peng
- Department of Neurosurgery, Binzhou Medical University Hospital
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Adeleye AO, Ulasi BI. Single Frontal Burr-Hole Craniostomy Under Local Anesthesia for Treating Chronic Subdural Hematoma in the Septuagenarians and Older Adults: Surgical Technique and Results. INDIAN JOURNAL OF NEUROTRAUMA 2023. [DOI: 10.1055/s-0043-1762600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Abstract
Background Chronic subdural hematoma (CSDH) is not a totally benign disease in the elderly patients, especially those aged 70 years and above. Hence, the surgical treatment of CSDH in aged patients needs to be as minimally disruptive as possible.
Methods An annotated description of the surgical technique of single frontal burr-hole craniostomy performed under local anesthesia and without closed tube drainage for evacuating CSDH in the septuagenarians and older adults is given. We also review the outcome of the procedure on a prospective consecutive cohort of patients in our service
Results Thirty patients, 25 males, aged 70 years and above successfully underwent this surgical procedure. Their mean age was 76.5 years (standard deviation, 4.3). The CSDH was bilateral in 30% (9/30), and more left sided in the rest, the unilateral cases, and was of mixed density radiologically, in most cases (73%, 22/30). Clinical presentation was mainly gait impairment, cognitive decline, and headache, and 57% (17/30) presented with coma or stupor as assessed by the Markwalder grading scale.The surgery was successfully executed in all, median duration 45.0 minutes (interquartile range 37.3–60.0), and solely under local anesthesia in 77% (23/30) or with momentary short-acting sedation in the rest. The outcome was very good in 90.0% (27/30) using the modified Rankin Scale (mRS) including two-third (20/30) completely asymptomatic (mRS 0) and 7/30 with only slight symptoms/disability, mRS ≤ 2. Three patients died perioperatively, all presenting in coma.
Conclusion This surgical technique appears very effectual for CSDH, is executed at a comparatively low cost, and, being much less disruptive than other traditional methods, may be a more homeostatic operative treatment in geriatric patients at least.
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Affiliation(s)
- Amos Olufemi Adeleye
- Department of Surgery, Division of Neurological Surgery, College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria
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Miah IP, Blanter A, Tank Y, Zwet EWV, Rosendaal FR, Peul WC, Dammers R, Holl DC, Lingsma HF, den Hertog HM, van der Naalt J, Jellema K, der Gaag NAV. Change in Hematoma Size after Dexamethasone Therapy in Chronic Subdural Hematoma Subtypes: A Prospective Study in Symptomatic Patients. J Neurotrauma 2023; 40:228-239. [PMID: 36029208 DOI: 10.1089/neu.2022.0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The main treatment strategy for chronic subdural hematoma is surgical intervention. When a conservative pharmacological approach is considered in symptomatic patients, mainly dexamethasone therapy is applied. Recent trials revealed dexamethasone therapy to be an ineffective treatment in symptomatic patients with chronic subdural hematoma. Whether the efficacy of dexamethasone therapy differs in radiological hematoma subtypes is unknown. The aim of this substudy was to identify which hematoma subtype might be favorable for dexamethasone therapy. As part of a randomized controlled trial, symptomatic chronic subdural hematoma patients received 19-days dexamethasone therapy. The primary outcome measure was the change in hematoma size as measured on follow-up computed tomography (CT) after 2 weeks of dexamethasone in six hematoma (architectural and density) subtypes: homogeneous total, laminar, separated and trabecular architecture types, and hematoma without hyperdense components (homogeneous hypodense, isodense) and with hyperdense components (homogeneous hyperdense, mixed density). We analyzed hematoma thickness, midline shift, and volume using multi-variable linear regression adjusting for age, sex and baseline value of the specific radiological parameter. From September 2016 until February 2021, 85 patients were included with a total of 114 chronic subdural hematoma. The mean age was 76 years and 25% were women. Larger decrease in hematoma thickness and midline shift was revealed in hematoma without hyperdense components compared with hematoma with hyperdense components (adjusted [adj.] b -2.2 mm, 95% confidence interval [CI] -4.1 to -0.3 and adj. b -1.3 mm, 95% CI -2.7 to 0.0 respectively). Additional surgery was performed in 57% of patients with the highest observed rate (81%) in separated hematoma. Largest hematoma reduction and better clinical improvement was observed in chronic subdural hematoma without hyperdense components after dexamethasone therapy. Evaluation of these parameters can be part of an individualized treatment strategy.
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Affiliation(s)
- Ishita P Miah
- Department of Neurology, Amphia Hospital, Breda, the Netherlands
- Department of Neurology and Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology and Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Anastassia Blanter
- Department of Neurology and Neurosurgery, Haga Teaching Hospital, The Hague, the Netherlands
| | - Yeliz Tank
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik W van Zwet
- Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilco C Peul
- Department of Neurology and Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology and Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
- Department of Neurology and Neurosurgery, Haga Teaching Hospital, The Hague, the Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Dana C Holl
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hester F Lingsma
- Department of Public Health and Medical Decision Making, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Joukje van der Naalt
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Korné Jellema
- Department of Neurology and Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Niels A Van der Gaag
- Department of Neurology and Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology and Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands
- Department of Neurology and Neurosurgery, Haga Teaching Hospital, The Hague, the Netherlands
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Drake M, Ullberg T, Nittby H, Marklund N, Wassélius J. Swedish trial on embolization of middle meningeal artery versus surgical evacuation in chronic subdural hematoma (SWEMMA)—a national 12-month multi-center randomized controlled superiority trial with parallel group assignment, open treatment allocation and blinded clinical outcome assessment. Trials 2022; 23:926. [DOI: 10.1186/s13063-022-06842-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Chronic subdural hematoma (cSDH) is one of the most common neurosurgical disorders and the incidence is rising. The routine treatment is neurosurgical hematoma evacuation, which is associated with recurrence rates up to 10–25%. In recent years, endovascular embolization of the middle meningeal artery (eMMA) has garnered much attention due to recurrence rates as low as < 5%. Several randomized controlled trials are planned or ongoing. In most of these trials, conventional neurosurgical treatment with or without adjunctive endovascular embolization is compared. The proposed trial aims to conduct a head-to-head comparison between neurosurgical and endovascular treatment as stand-alone treatments.
Methods
The trial is academically driven and funded within existing public healthcare systems and infrastructure. Patients with uni- or bilateral cSDH, presenting with mild-to moderate symptoms, and admitted to neurosurgery on clinical grounds will be offered participation. Subjects are randomized 1:1 between conventional neurosurgical treatment (control) and endovascular embolization of the middle meningeal artery (intervention). Primary endpoint is reoperation due to clinically and/or radiologically significant recurrence within 3 months. Secondary endpoints include safety, technical success rate, neurological disability, and quality of life.
Discussion
There are mounting retrospective data suggesting eMMA, as sole treatment or as an adjunctive to neurosurgery for cSDH, is safe and effective with a reoperation rate lower than neurosurgical hematoma evacuation alone. If randomized controlled trials confirm these findings, there is a potential for a paradigm shift in the treatment of cSDH where a minimally invasive procedure can replace open surgery in a large and oftentimes old and fragile patient cohort.
Trial registration
ClinicalTrials.gov, ClinicalTrials.gov Identifier NCT05267184. Registered March 4, 2022.
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González-Vargas PM, Thenier-Villa JL, Calero Félix L, Galárraga Campoverde RA, Martín-Gallego Á, de la Lama Zaragoza A, Conde Alonso CM. Factors that negatively influence the Glasgow Outcome Scale in patients with chronic subdural hematomas. An analytical and retrospective study in a tertiary center. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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6
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Zhang P, Li Y, Huang J, Zhang H, Wang X, Dong L, Yan Z, She L. Chronic subdural haematoma in antithrombotic cohorts: characteristics, surgical outcomes, and recurrence. Br J Neurosurg 2020; 34:408-415. [DOI: 10.1080/02688697.2020.1749987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Peng Zhang
- Department of Neurosurgery, DaLian Medical University, DaLian, China
| | - Yuping Li
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Jiannan Huang
- Department of Neurosurgery, DaLian Medical University, DaLian, China
| | - Hengzhu Zhang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xiaodong Wang
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Lun Dong
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Zhengcun Yan
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Lei She
- Department of Neurosurgery, Clinical Medical College of Yangzhou University, Yangzhou, China
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7
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High frequency of ophthalmic origin of the middle meningeal artery in chronic subdural hematoma. Neuroradiology 2020; 62:639-644. [DOI: 10.1007/s00234-020-02363-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
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8
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Fiorella D, Arthur AS. Middle meningeal artery embolization for the management of chronic subdural hematoma. J Neurointerv Surg 2019; 11:912-915. [DOI: 10.1136/neurintsurg-2019-014730] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 01/25/2023]
Abstract
Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diagnoses in adults. The disease is fundamentally a disorder of the meningeal blood vessels, and options exist for the minimally invasive neuroendovascular management. We review the potential role for the endovascular management of cSDH within the context of a discussion of the epidemiology, pathophysiology, and conventional management of this disease.
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The Pathogenesis of Chronic Subdural Hematomas: A Study on the Formation of Chronic Subdural Hematomas and Analysis of Computed Tomography Findings. World Neurosurg 2017; 107:376-381. [DOI: 10.1016/j.wneu.2017.07.108] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 11/21/2022]
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10
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Kale A, Öz İİ, Gün EG, Kalaycı M, Gül Ş. Is the recurrence rate of chronic subdural hematomas dependent on the duration of drainage? Neurol Res 2017; 39:399-402. [DOI: 10.1080/01616412.2017.1296655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Aydemir Kale
- Faculty of Medicine, Department of Neurosurgery, Bülent Ecevit University, Zonguldak, Turkey
| | - İbrahim İlker Öz
- Faculty of Medicine, Department of Radiology, Bülent Ecevit University, Zonguldak, Turkey
| | - Eren Görkem Gün
- Faculty of Medicine, Department of Neurosurgery, Bülent Ecevit University, Zonguldak, Turkey
| | - Murat Kalaycı
- Faculty of Medicine, Department of Neurosurgery, Bülent Ecevit University, Zonguldak, Turkey
| | - Şanser Gül
- Faculty of Medicine, Department of Neurosurgery, Bülent Ecevit University, Zonguldak, Turkey
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11
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Treatment of chronic subdural hematoma by novel YL-1 hollow needle aspiration drainage system (697 cases report). Neurol Sci 2016; 38:109-113. [DOI: 10.1007/s10072-016-2717-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/14/2016] [Indexed: 11/26/2022]
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12
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Unterhofer C, Freyschlag CF, Thomé C, Ortler M. Opening the Internal Hematoma Membrane Does Not Alter the Recurrence Rate of Chronic Subdural Hematomas: A Prospective Randomized Trial. World Neurosurg 2016; 92:31-36. [DOI: 10.1016/j.wneu.2016.04.081] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
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Preoperative predictive factors for surgical and functional outcomes in chronic subdural hematoma. Acta Neurochir (Wien) 2016; 158:135-9. [PMID: 26602235 DOI: 10.1007/s00701-015-2625-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a frequently encountered neurosurgical condition, especially in the elderly. We investigated predictive factors for surgical and functional outcomes after burr-hole drainage (BHD) surgery. METHODS All patients with CSDH treated by BHD between January 2012 and December 2014 were included in this study. All patients were classified by symptom, clinical grade, time, location, hematoma density, midline shift, and other characteristics. Pre- and postoperative CT evaluation was performed at 0, 3, and 6 months. Clinical grades were classified as described in Markwalder et al. Surgical and clinical outcomes were evaluated with the brain expansion rate and modified Rankin Scale (mRS). Brain expansion rate was calculated as the ratio between post- and pre-operative hematoma thickness. Recurrence was defined as the occurrence of symptoms and hematoma on CT within 6 months. RESULTS This study included 130 patients over 2 years. Among the variable parameters, young age (<75), iso-density of hematoma on CT, and short duration from symptom to surgery were correlated with good brain expansion. Patients with good brain expansion had fewer recurrences. In terms of mRS, young age, iso-density, and good clinical grade were correlated with good functional outcomes. CONCLUSIONS Clinicians should be more aware of general conditions and medical problems, especially in elderly patients. Membranectomy should be considered in patients with a long duration of symptoms or hypo-dense hematomas to promote good brain expansion and good mRS scores.
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Pang CH, Lee SE, Kim CH, Kim JE, Kang HS, Park CK, Paek SH, Kim CH, Jahng TA, Kim JW, Kim YH, Kim DG, Chung CK, Jung HW, Yoo H. Acute intracranial bleeding and recurrence after bur hole craniostomy for chronic subdural hematoma. J Neurosurg 2015; 123:65-74. [DOI: 10.3171/2014.12.jns141189] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
There is inconsistency among the perioperative management strategies currently used for chronic subdural hematoma (cSDH). Moreover, postoperative complications such as acute intracranial bleeding and cSDH recurrence affect clinical outcome of cSDH surgery. This study evaluated the risk factors associated with acute intracranial bleeding and cSDH recurrence and identified an effective perioperative strategy for cSDH patients.
METHODS
A retrospective study of patients who underwent bur hole craniostomy for cSDH between 2008 and 2012 was performed.
RESULTS
A consecutive series of 303 cSDH patients (234 males and 69 females; mean age 67.17 years) was analyzed. Postoperative acute intracranial bleeding developed in 14 patients (4.57%) within a mean of 3.07 days and recurrence was observed in 37 patients (12.21%) within a mean of 31.69 days (range 10–104 days) after initial bur hole craniostomy. The comorbidities of hematological disease and prior shunt surgery were clinical factors associated with acute bleeding. There was a significant risk of recurrence in patients with diabetes mellitus, but recurrence did not affect the final neurological outcome (p = 0.776). Surgical details, including the number of operative bur holes, saline irrigation of the hematoma cavity, use of a drain, and type of postoperative ambulation, were not significantly associated with outcome. However, a large amount of drainage was associated with postoperative acute bleeding.
CONCLUSIONS
Bur hole craniostomy is an effective surgical procedure for initial and recurrent cSDH. Patients with hematological disease or a history of prior shunt surgery are at risk for postoperative acute bleeding; therefore, these patients should be carefully monitored to avoid overdrainage. Surgeons should consider informing patients with diabetes mellitus that this comorbidity is associated with an increased likelihood of recurrence.
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Affiliation(s)
- Chang Hwan Pang
- 1Department of Neurosurgery, Seoul National University Hospital
| | - Soo Eon Lee
- 1Department of Neurosurgery, Seoul National University Hospital
| | - Chang Hyeun Kim
- 1Department of Neurosurgery, Seoul National University Hospital
| | - Jeong Eun Kim
- 1Department of Neurosurgery, Seoul National University Hospital
- 3Department of Neurosurgery, Seoul National University College of Medicine; and
| | - Hyun-Seung Kang
- 1Department of Neurosurgery, Seoul National University Hospital
- 3Department of Neurosurgery, Seoul National University College of Medicine; and
| | - Chul-Kee Park
- 1Department of Neurosurgery, Seoul National University Hospital
- 3Department of Neurosurgery, Seoul National University College of Medicine; and
| | - Sun Ha Paek
- 1Department of Neurosurgery, Seoul National University Hospital
- 3Department of Neurosurgery, Seoul National University College of Medicine; and
| | - Chi Heon Kim
- 1Department of Neurosurgery, Seoul National University Hospital
- 3Department of Neurosurgery, Seoul National University College of Medicine; and
| | - Tae-Ahn Jahng
- 2Department of Neurosurgery, Bundang Seoul National University Hospital
- 3Department of Neurosurgery, Seoul National University College of Medicine; and
| | - Jin Wook Kim
- 2Department of Neurosurgery, Bundang Seoul National University Hospital
| | - Yong Hwy Kim
- 1Department of Neurosurgery, Seoul National University Hospital
| | - Dong Gyu Kim
- 1Department of Neurosurgery, Seoul National University Hospital
- 3Department of Neurosurgery, Seoul National University College of Medicine; and
| | - Chun Kee Chung
- 1Department of Neurosurgery, Seoul National University Hospital
- 3Department of Neurosurgery, Seoul National University College of Medicine; and
| | - Hee-Won Jung
- 1Department of Neurosurgery, Seoul National University Hospital
- 3Department of Neurosurgery, Seoul National University College of Medicine; and
| | - Heon Yoo
- 4Department of Neurosurgery, National Cancer Center, Seoul, Korea
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Effects of Newly Designed Drainage Catheter in Treating Chronic Subdural Hematoma. Korean J Neurotrauma 2013. [DOI: 10.13004/kjnt.2013.9.2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Requejo PR, Vaitsman RP, Paiva MS, Machado AL, Barroso MV, Salame JM, Louzada PR. Interhemispheric chronic subdural haematoma: Case report and brief review of the literature. Brain Inj 2010; 24:1039-43. [DOI: 10.3109/02699052.2010.489034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Hwang SC, Im SB, Kim BT, Shin WH. Safe entry point for twist-drill craniostomy of a chronic subdural hematoma. J Neurosurg 2009; 110:1265-70. [DOI: 10.3171/2008.9.jns08359] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Twist-drill craniostomy (TDC) with closed-system drainage is an effective treatment option for chronic subdural hematoma (CSDH). Because the entry point for TDC has not been described in a definitive area, the aim of this study was to define the optimal twist-drill entry point for CSDH.
Methods
The authors selected 40 random cases involving selective catheter angiography of the external carotid artery, regardless of study purpose, to evaluate the course of the middle meningeal artery. Furthermore, 50 skull radiographs were reviewed to assess the relation of the vascular groove to the coronal suture. On the basis of the radiological anatomical study, the authors propose that the normal TDC entry point should be 1 cm anterior to the coronal suture at the level of the superior temporal line (STL). Thirty patients with symptomatic CSDH were treated using TDC with closed-system drainage at the proposed entry point. The thicknesses of the hematoma and the skull were measured at the proposed entry point. The congruence between the proposed entry point and postoperative craniostomy was estimated and complications were evaluated.
Results
In the radiological study, all the branches of the middle meningeal artery ran posterior to the coronal suture and the vascular grooves were also located posterior to the coronal suture at the level of the STL. The average distance of the vascular grooves was 8.0 ±5.8 mm. Thirty-five procedures were performed. The coronal suture and the STL could be identified clearly on brain CT scans. The mean thickness of the skull and the CSDH at the proposed point was 8 mm (range 5–13 mm) and 20 mm (range 10–28 mm), respectively. All the TDCs except 1 were congruent with the preoperative brain CT scans. One CSDH recurred 1 month after the first operation and was revised using the same procedure. No other complications occurred.
Conclusions
One centimeter anterior to the coronal suture at the level of the STL is suitable as the normal entry point of the TDC for symptomatic CSDH. The thickness of the CSDH can be measured at this point on a preoperative brain CT scan. Furthermore, the entry point on the scalp can be accurately estimated using surface landmarks.
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Takeda N, Sasaki K, Oikawa A, Aoki N, Hori T. A new simple therapeutic method for chronic subdural hematoma without irrigation and drainage. Acta Neurochir (Wien) 2006; 148:541-6. [PMID: 16598410 DOI: 10.1007/s00701-005-0689-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 10/06/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND We developed a new simple therapeutic method for the treatment of chronic subdural hematoma (CSDH) without irrigation and drainage. This method is characterized by replacement of the hematoma with oxygen. METHODS Seventy patients (seventy-eight sides) with CSDH were treated with this method from May 1994 to October 2002. For the complete replacement of the hematoma with oxygen, subdural tapping site was changed from the thickest area of the hematoma to the parietal tuber. Irrigation and drainage were not used in all patients. RESULTS Neurological recovery after the treatment was satisfactory in all 70 patients. An average amount of replaced hematoma was 96.1 ml, ranging from 5 to 280 ml. An initial hematoma pressure ranged from 0 to 200 mm H2O (average: 92.1 mm H2O). During the follow up periods, clinical recurrence was noted in 7 patients (10%) and 7 sides (9.0%). CONCLUSION The replacement of the hematoma with oxygen via percutaneous subdural tapping without irrigation and drainage is useful and less invasive method for the treatment of CSDH.
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Affiliation(s)
- N Takeda
- Department of Neurosurgery, Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, and Department of Neurosurgery, Tokyo Women's Medical University, Japan.
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Erol FS, Topsakal C, Faik Ozveren M, Kaplan M, Tiftikci MT. Irrigation vs. closed drainage in the treatment of chronic subdural hematoma. J Clin Neurosci 2006; 12:261-3. [PMID: 15851078 DOI: 10.1016/j.jocn.2003.09.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2003] [Accepted: 09/27/2003] [Indexed: 10/25/2022]
Abstract
A number of different techniques are used to treat chronic subdural hematomas surgically. In this study, 70 chronic subdural hematomas were surgically treated and analyzed prospectively. Patients were classified according to clinical features and computed tomography images. Results of the cases that underwent burr-hole craniostomy-irrigation (group A; n=35) were compared with those undergoing burr-hole craniostomy-closed system drainage (group B; n=35). The most common etiological factor was trauma in both groups. Complete resolution in the early period was higher in group B compared to group A (60% vs. 40%). However, no difference was noted at the first month-follow-up. Recurrence rates were 17% in group A and 14% in group B. No significant difference was noted in terms of hospitalization duration or postoperative complications. In conclusion, we believe that the burr-hole craniostomy-irrigation technique is a reliable and effective method compared to burr-hole craniostomy-closed system drainage in the treatment of chronic subdural hematoma.
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Affiliation(s)
- Fatih S Erol
- Department of Neurosurgery, Firat University School of Medicine, Elazig, Turkey.
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Voelker JL, Sambasivan M. The Role of Craniotomy and Trephination in the Treatment of Chronic Subdural Hematoma. Neurosurg Clin N Am 2000. [DOI: 10.1016/s1042-3680(18)30119-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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