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Weber W, Campbell T, Papandria T, Ahmadpour A. Intracranial Intraosseous Catheter Placement to Temporize an Epidural Hematoma. Ann Emerg Med 2023; 82:505-508. [PMID: 37341666 DOI: 10.1016/j.annemergmed.2023.05.009] [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: 11/10/2022] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 06/22/2023]
Abstract
Acute epidural hematomas can lead to rapid neurologic decompensation and death. Epidural hematomas may require emergency surgical clot removal, but many patients live far away from a trauma center. This case report describes a pediatric patient with an acute epidural hematoma with significant neurologic compromise who initially presented to a nontrauma center. The emergency department (ED) had no neurosurgeon or equipment to perform burr hole craniostomy. The emergency physician at the nontrauma ED inserted an intraosseous catheter intracranially to temporarily decompress the hematoma due to long transport times. The patient survived with complete neurologic recovery. This is the youngest known patient in whom an intraosseous catheter was used to drain an intracranial hematoma.
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Affiliation(s)
- William Weber
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard University School of Medicine, Boston, MA.
| | - Teri Campbell
- University of Chicago Aeromedical Network, University of Chicago, Chicago, IL
| | - Thomas Papandria
- University of Chicago Aeromedical Network, University of Chicago, Chicago, IL
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2
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Duvvi A, Ganji M, Habal Y, Bekele H, Kim C, Yates E, Seligson S, McWhir G, Kalantari H, Singh J, Hassen GW. Emergency department burr hole simulation using 3D-printed model. Am J Emerg Med 2023; 71:104-108. [PMID: 37356338 DOI: 10.1016/j.ajem.2023.06.032] [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: 05/06/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Traumatic epidural hematoma (EDH) with the potential to displace the brain tissue and increase intracranial pressure (ICP), is a life-threatening condition that requires emergent intervention. In rare circumstances, Emergency Physician (EP) may have to do skull trephination to reduce the ICP as a temporary measure. SPECIFIC AIMS To evaluate emergency medicine (EM) residents' comfort in performing emergency department (ED) burr holes and to assess their difficulties and evaluate comfort level before and after simulated EDH cases. MATERIALS AND METHODS A 3D-printed skull and electrical and manual drills were used for the simulation. Subjective comfort level pre and post-procedure, as well as objective procedural skills and time to complete the drill, were recorded. RESULTS Twenty EM residents participated in the simulation study. The median time to perforate through the skull was 4 s for the electric drill and 10 s for the manual drill. A comfort level of 5 and above was reported by 12 participants for the manual drill and by 17 participants for the electric drill. Six participants had mild and 2 participants had moderate observed difficulty in handling the manual and electric drill. Most participants performed both procedures successfully with one attempt only. Three participants have an overall comfort level above 5 before the simulation and 13 participants had a post-simulation. CONCLUSION The 3D-printed model assisted the ED burr hole simulation and the residents could perform the procedure with minimum difficulties.
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Affiliation(s)
- Anisha Duvvi
- Albert Einstein School of Medicine, USA; Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Mohammad Ganji
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Yasmine Habal
- Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Hebron Bekele
- Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Ceilim Kim
- Metropolitan Hospital Center, Department of Emergency Medicine, USA; Columbia University, Postbac Premed Program, USA
| | - Evan Yates
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Shterna Seligson
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Greg McWhir
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Hossein Kalantari
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Jaspreet Singh
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA
| | - Getaw Worku Hassen
- NYMC, Metropolitan Hospital Center, Department of Emergency Medicine, USA.
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3
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Usman B, Mohammed B, Daibu U. Outcomes of Evacuating Subacute Extradural Hematoma Through a Minicraniectomy: A 5-Year Study. INDIAN JOURNAL OF NEUROTRAUMA 2023. [DOI: 10.1055/s-0043-1760742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract
Background Extradural hematoma (EDH) is a hematoma between the dura and the inner surface of the skull, found in 1 to 3% of all head-injured patients, rising to 9% among the unconscious ones. It is said to be subacute when about 2 to 4 days old. Further enlargement of the burr hole to about 3 to 5 cm wide (minicraniectomy) may allow its total evacuation.
Objective To recommend it as a treatment option, this study aims to evaluate the surgical outcomes of evacuating a subacute EDH through a minicraniectomy.
Method This was a 5-year prospective study in a Nigerian tertiary health institution.
Results In total, 108 patients, consisting of 96 males and 12 females with a male to female ratio of 8:1 were included. Their ages ranged from 10 to 69 years. Etiologies were road traffic accident (RTA, 73.2%), assault (18.5%), and falls (8.3%). Hematoma ages were 2 days (61.1%), 3 days (25%), 4 days (13.9%). GCS were mild (11%), moderate (56%), and severe (33%). Locations were right-sided (59.3%), left-sided (40.7%) with 73.1% in parietotemporal area. Active bleeding was encountered in 15% only. Postoperative complications were seizure (13.9%), death (12%), and surgical site infection (4.6%) among others. Outcomes at 2 weeks were good (83, 76.9%), moderate disability (12, 11.1%), severe disability (10, 9.3%), vegetative (1, 0.9%), and death (2, 1.9%).
Conclusion Considering the significant morbidity and mortality and the need for urgent interventions in EDH, most patients presenting in the subacute acute (2– 4 days) stage can be evacuated via a minicraniectomy with good outcomes.
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Affiliation(s)
- Babagana Usman
- Neurosurgery Unit, Surgery Department, The University of Maiduguri and the University of Maiduguri Teaching Hospital, Borno State, Nigeria
- Visiting Neurosurgeon to the Surgery Department, Federal Medical Centre, Yola, Adamawa State, Nigeria
| | - Babagana Mohammed
- Neurosurgery Unit, Surgery Department, The University of Maiduguri and the University of Maiduguri Teaching Hospital, Borno State, Nigeria
| | - Usman Daibu
- Neurosurgery Unit, Surgery Department, The University of Maiduguri and the University of Maiduguri Teaching Hospital, Borno State, Nigeria
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Grossman M, See AP, Mannix R, Simon EL. Complete Neurological Recovery After Emergency Burr Hole Placement Utilizing EZ-IO® for Epidural Hematoma. J Emerg Med 2022; 63:557-560. [DOI: 10.1016/j.jemermed.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/04/2022] [Indexed: 12/05/2022]
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Wu JC, Cao K, Mayfield J, Ganti L. Emergency Decompressive Craniostomy “Burr Hole” Using an Intraosseous Vascular Access System in a Resource-Limited Setting: A Technical Report on a Cadaver. Cureus 2022; 14:e24420. [PMID: 35619862 PMCID: PMC9126472 DOI: 10.7759/cureus.24420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/05/2022] Open
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Fan G, Wang H, Ding J, Xu C, Liu Y, Wang C, Li Z. Application of Absolute Alcohol in the Treatment of Traumatic Intracranial Hemorrhage via Interventional Embolization of Middle Meningeal Artery. Front Neurol 2020; 11:824. [PMID: 32903661 PMCID: PMC7438730 DOI: 10.3389/fneur.2020.00824] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 06/30/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Traumatic brain injury is a common condition in neurosurgery. Traditional methods of treatment include conservative treatment and surgical evacuation using burr-holes or craniotomy; however, studies have reported problems such as high re-expansion rates after conservative treatment of epidural hematoma and high postoperative recurrence rates of subdural hematoma. Solutions to these problems are lacking, and research into new treatment methods is ongoing. Among the potential new treatments, middle meningeal arterial embolization is an option. This study involved patients with acute epidural hematoma and chronic subdural hematoma. The purpose was to evaluate the use and effects of absolute alcohol to embolize the middle meningeal artery to treat intracranial hematoma. Material and Methods: A retrospective description study was 12 cases of intracranial hematoma who treated with absolute alcohol interventional therapy from our hospital between June 2018 and October 2019. Five patients with acute epidural hematoma and seven patients with chronic subdural hematoma were treated using absolute alcohol to embolize the middle meningeal artery. Patients' clinical data, imaging results, surgical results, and prognosis were recorded and analyzed. Results: All patients underwent absolute alcohol embolization of the middle meningeal artery, in combination with burr-hole drainage. All imaging data were confirmed preoperatively. We successfully used absolute alcohol to embolize the middle meningeal artery intraoperatively and confirmed these results by postoperative angiography. All patients achieved symptomatic relief without complications, and no recurrence or re-expansion was seen with follow-up computed tomography. Our study has been registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn, ChiCTR1800018714). Conclusion: The use of absolute alcohol to embolize the middle meningeal artery could be used as an attempt to treat acute epidural hematoma and chronic subdural hematoma.
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Affiliation(s)
- Gangxian Fan
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Henglu Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Jinke Ding
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chao Xu
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Yongliang Liu
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chao Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Zefu Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
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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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McClung CD, Anshus JS, Anshus AJ, Baker SR. Bedside Craniostomy and Serial Aspiration with an Intraosseous Drill/Needle to Temporize an Acute Epidural Hemorrhage with Mass Effect. World Neurosurg 2020; 142:218-221. [PMID: 32634633 DOI: 10.1016/j.wneu.2020.06.215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND This report describes a technique for an immediate mechanical intervention using a familiar tool for emergency physicians and trauma surgeons to temporize acute epidural bleeding with mass effect. The Monro-Kellie Doctrine suggests that immediate removal of some blood will reduce intracranial pressure and mitigate some of the deleterious effects until the neurosurgeon can respond. CASE DESCRIPTION A 38-year-old male with active extradural hemorrhage and expanding hemtoma with mass effect and herniation was treated at the bedside with an intraosseous drill to perform craniostomy and allow serial aspirations of continued bleeding. CONCLUSIONS Bedside craniosotmy with an intraosseous drill can allow for immediate temporizing of a large epidural hemorrhage and be applied by emergency physicians and/or trauma specialists when neurosurgical consultation is delayed. Serial aspirations should be performed when hemorrhage is ongoing and until definitive evacuation is performed.
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Affiliation(s)
- Christian D McClung
- Department of Emergency Medicine, Palomar Health, Escondido, California, USA; Department of Molecular Microbiology and Immunology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
| | - John S Anshus
- Department of Emergency Medicine, Palomar Health, Escondido, California, USA
| | - Alexander J Anshus
- Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, California, USA
| | - Stephen R Baker
- Department of Emergency Nursing, Palomar Health, Escondido, California, USA
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Howard A, Krishnan V, Lane G, Caird J. Cranial burr holes in the emergency department: to drill or not to drill? Emerg Med J 2019; 37:151-153. [PMID: 31888954 DOI: 10.1136/emermed-2019-208943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/22/2019] [Accepted: 12/09/2019] [Indexed: 11/03/2022]
Abstract
The practice of trepanning (referred to today as a craniotomy) dates back to the Neolithic period. Reasons for drilling a hole through the skull evolved from releasing evil spirits and curing insanity to practical management of head injuries in ancient Greece and Rome. Today, craniotomy or drilling a burr hole through the skull is very much the purview of the neurosurgeon. Yet one could argue that the procedure itself is more 'bone surgery' than 'brain surgery'. Nevertheless, despite the fact that head injury is a common presentation at district general hospitals and traumatic extra-axial haemorrhages are encountered often, the straightforward skillset required to drill a burr hole as a pretransfer, temporising, life-saving measure is seldom taught and has never gained traction. What we advocate in this article is the adaptation and novel application of an old, tried and tested technique in new hands. The critical pathophysiological turning point of any expanding extra-axial haemorrhage is the inflection point on the volume/Intracranial pressure (ICP) curve beyond which compensation is impossible. The subsequent rising ICP initiates a predictable continuum of clinical signs signalling progressive herniation. There are few emergencies as time-critical as a patient with an isolated, expanding extradural haemorrhage embarking on a trajectory of rostrocaudal deterioration and inevitable death. In many cases, the tragedy is compounded by the knowledge that such a patient probably has a healthy underlying brain, often evidenced by a lucid period after trauma. Our emergency department is attached to a small 300-bed District General Hospital (DGH) on the rural North West coast of Ireland. We are 262 km distant by road from a national neurosciences department that can, at best, be reached in 2 hours and 30 min. Quality improvement review of years of dismal outcomes in patients such as those described earlier with potentially remediable pathology prompted research and development of the skillset we are now able to offer, an old technique in new hands.
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Affiliation(s)
- Alan Howard
- Emergency Department, Letterkenny University Hospital, Letterkenny, Donegal, Ireland
| | - Vinaithan Krishnan
- Emergency Department, Letterkenny University Hospital, Letterkenny, Donegal, Ireland
| | - Gerard Lane
- Emergency Department, Letterkenny University Hospital, Letterkenny, Donegal, Ireland
| | - John Caird
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
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10
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Durnford S, Bulstrode H, Durnford A, Chakraborty A, Tarmey NT. Temporising an extradural haematoma by intraosseous needle craniostomy in the District General Hospital by non-neurosurgical doctors - A case report. J Intensive Care Soc 2018; 19:76-79. [PMID: 29456607 PMCID: PMC5810882 DOI: 10.1177/1751143717734997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report the case of a 69-year-old man admitted to the emergency department of a UK district general hospital with an extradural haematoma following closed head injury. He deteriorated rapidly before transfer to the regional neurosurgical centre and was treated with decompression of the extradural haematoma through an EZ-IO™ intraosseous needle in our department, with telephone guidance from the neurosurgeon. We believe this to be the first reported use of this technique in a district general hospital.
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Affiliation(s)
- Sahra Durnford
- Department of Critical Care, Queen Alexandra Hospital, Portsmouth, UK
| | - Harry Bulstrode
- Wessex Neurosurgical Centre, University Hospital Southampton, UK
| | - Andrew Durnford
- Wessex Neurosurgical Centre, University Hospital Southampton, UK
| | | | - Nicholas T Tarmey
- Department of Critical Care, Queen Alexandra Hospital, Portsmouth, UK
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11
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Zhang Y, Li Q, Zhao R, Yang Z, Li Y, Min W, Yue Z, Liu J. Novel Minimally Invasive Treatment Strategy for Acute Traumatic Epidural Hematoma: Endovascular Embolization Combined with Drainage Surgery and Use of Urokinase. World Neurosurg 2017; 110:206-209. [PMID: 29158097 DOI: 10.1016/j.wneu.2017.11.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/05/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hematoma evacuation is regular treatment for acute traumatic epidural hematoma (ATEDH) patients meeting with surgery indications. However, it is an invasive approach performed under general anesthesia. Here, a novel minimally invasive method of endovascular embolization with subsequent drainage surgery and use of urokinase was established to treat ATEDH under local anesthesia. METHODS A novel minimally invasive method of endovascular embolization with subsequent drainage surgery and use of urokinase was established to treat ATEDH under local anesthesia. Firstly, 23 ATEDH patients with hematomas in the temporal area underwent digital subtraction angiography detecting the bleeding point. Next, embolization was performed. After embolization, drainage surgery was taken and urokinase was injected into the hematoma cyst by drainage tube to lyse hematoma twice per day. RESULTS The results showed that the middle meningeal artery was the bleeding source. Embolization immediately ceased bleeding. Most clots were resolved and drained after treatment. No recurrence of hematoma or infection was observed. CONCLUSION The findings suggest that the combined treatments can be an alternative minimally invasive option for ATEDHs, especially for elderly patients or those contraindicated for general anesthesia.
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Affiliation(s)
- Yuhui Zhang
- Department of Spine Surgery, Renji Hospital, Medical School, Shanghai Jiaotong University, Shanghai, China
| | - Qiang Li
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rui Zhao
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhigang Yang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yanan Li
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Weijie Min
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhijian Yue
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
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12
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Yue JK, Rick JW, Deng H, Feldman MJ, Winkler EA. Efficacy of decompressive craniectomy in the management of intracranial pressure in severe traumatic brain injury. J Neurosurg Sci 2017; 63:425-440. [PMID: 29115100 DOI: 10.23736/s0390-5616.17.04133-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Traumatic brain injury (TBI) is a common cause of permanent disability for which clinical management remains suboptimal. Elevated intracranial pressure (ICP) is a common sequela following TBI leading to death and permanent disability if not properly managed. While clinicians often employ stepwise acute care algorithms to reduce ICP, a number of patients will fail medical management and may be considered for surgical decompression. Decompressive craniectomy (DC) involves removing a component of the bony skull to allow cerebral tissue expansion in order to reduce ICP. However, the impact of DC, which is performed in the setting of neurological instability, ongoing secondary injury, and patient resuscitation, has been challenging to study and outcomes are not well understood. This review summarizes historical and recent studies to elucidate indications for DC and the nuances, risks and complications in its application. The pathophysiology driving ICP elevation, and the corresponding medical interventions for their temporization and treatment, are thoroughly described. The current state of DC - including appropriate injury classification, surgical techniques, concurrent medical therapies, mortality and functional outcomes - is presented. We also report on the recent updates from large randomized controlled trials in severe TBI (Decompressive Craniectomy [DECRA] and Randomized Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of ICP [RESCUEicp]), and recommendations for early DC to treat refractory ICP elevations in malignant middle cerebral artery syndrome. Limitations for DC, such as the equipoise between immediate reduction in ICP and clinically meaningful functional outcomes, are discussed in support of future investigations.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Jonathan W Rick
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Hansen Deng
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Michael J Feldman
- Department of Neurological Surgery, Vanderbilt University, Nashville, TN, USA
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, CA, USA -
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13
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Sheng HS, You CG, Yang L, Zhang N, Lin J, Lin FC, Wang MD. Trephination mini-craniectomy for traumatic posterior fossa epidural hematomas in selected pediatric patients. Chin J Traumatol 2017; 20:212-215. [PMID: 28688799 PMCID: PMC5555239 DOI: 10.1016/j.cjtee.2017.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Posterior fossa epidural hematomas (PFEDH) are uncommon in children but usually require timely surgical intervention due to the risk of life-threatening brainstem compression. We attempt to make the surgical procedure less invasive by treating selected pediatric patients with trephination mini-craniectomy. METHODS We retrospectively reviewed the clinical courses, radiological findings, surgical procedures, and prognoses of the pediatric patients who were treated in our departments for traumatic PFEDH from January 2010 to January 2015. RESULTS During this period, a total of 17 patients were surgically treated for PFEDH and 7 were managed with trephination mini-craniectomy for hematoma evacuation. The outcomes were good in all 7 patients as evaluated with Glasgow Outcome Score. There was no mortality in this series. The on average 30-month clinical follow-up showed that patients experienced satisfactory recoveries without complications. CONCLUSION Our results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients' neurological functions or the hematomas are large and exerted severe mass effects.
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Affiliation(s)
- Han-Song Sheng
- Department of Neurosurgery, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China; Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chao-Guo You
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Yang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nu Zhang
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jian Lin
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fen-Chun Lin
- Department of Neurosurgery, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mao-De Wang
- Department of Neurosurgery, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China.
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14
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Lin H, Wang WH, Hu LS, Li J, Luo F, Lin JM, Huang W, Zhang MS, Zhang Y, Hu K, Zheng JX. Novel Clinical Scale for Evaluating Pre-Operative Risk of Cerebral Herniation from Traumatic Epidural Hematoma. J Neurotrauma 2016; 33:1023-33. [PMID: 25393339 DOI: 10.1089/neu.2014.3656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Secondary massive cerebral infarction (MCI) is the predominant prognostic factor for cerebral herniation from epidural hematoma (EDH) and determines the need for decompressive craniectomy. In this study, we tested the clinical feasibility and reliability of a novel pre-operative risk scoring system, the EDH-MCI scale, to guide surgical decision making. It is comprised of six risk factors, including hematoma location and volume, duration and extent of cerebral herniation, Glasgow Coma Scale score, and presence of preoperative shock, with a total score ranging from 0 to 18 points. Application of the EDH-MCI scale to guide surgical modalities for initial hematoma evacuation surgery for 65 patients (prospective cohort, 2012.02-2014.01) showed a significant improvement in the accuracy of the selected modality (95.38% vs. 77.95%; p = 0.002) relative to the results for an independent set of 126 patients (retrospective cohort, 2007.01-2012.01) for whom surgical modalities were decided empirically. Results suggested that simple hematoma evacuation craniotomy was sufficient for patients with low risk scores (≤9 points), whereas decompressive craniectomy in combination with duraplasty were necessary only for those with high risk scores (≥13 points). In patients with borderline risk scores (10-12 points), those having unstable vital signs, coexistence of severe secondary brainstem injury, and unresponsive dilated pupils after emergent burr hole hematoma drainage had a significantly increased incidence of post-traumatic MCI and necessity of radical surgical treatments. In conclusion, the novel pre-operative risk EDH-MCI evaluation scale has a satisfactory predictive and discriminative performance for patients who are at risk for the development of secondary MCI and therefore require decompressive craniectomy.
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Affiliation(s)
- Hong Lin
- Department of Neurosurgery, The 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University , Center of Traumatic Neurosurgery in Nanjing Military Command, Zhangzhou, China
| | - Wen-Hao Wang
- Department of Neurosurgery, The 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University , Center of Traumatic Neurosurgery in Nanjing Military Command, Zhangzhou, China
| | - Lian-Shui Hu
- Department of Neurosurgery, The 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University , Center of Traumatic Neurosurgery in Nanjing Military Command, Zhangzhou, China
| | - Jun Li
- Department of Neurosurgery, The 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University , Center of Traumatic Neurosurgery in Nanjing Military Command, Zhangzhou, China
| | - Fei Luo
- Department of Neurosurgery, The 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University , Center of Traumatic Neurosurgery in Nanjing Military Command, Zhangzhou, China
| | - Jun-Ming Lin
- Department of Neurosurgery, The 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University , Center of Traumatic Neurosurgery in Nanjing Military Command, Zhangzhou, China
| | - Wei Huang
- Department of Neurosurgery, The 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University , Center of Traumatic Neurosurgery in Nanjing Military Command, Zhangzhou, China
| | - Ming-Sheng Zhang
- Department of Neurosurgery, The 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University , Center of Traumatic Neurosurgery in Nanjing Military Command, Zhangzhou, China
| | - Yuan Zhang
- Department of Neurosurgery, The 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University , Center of Traumatic Neurosurgery in Nanjing Military Command, Zhangzhou, China
| | - Kang Hu
- Department of Neurosurgery, The 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University , Center of Traumatic Neurosurgery in Nanjing Military Command, Zhangzhou, China
| | - Jian-Xian Zheng
- Department of Neurosurgery, The 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University , Center of Traumatic Neurosurgery in Nanjing Military Command, Zhangzhou, China
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Wang WH, Hu LS, Lin H, Li J, Luo F, Huang W, Lin JM, Cai GP, Liu CC. Risk Factors for Post-Traumatic Massive Cerebral Infarction Secondary to Space-Occupying Epidural Hematoma. J Neurotrauma 2014; 31:1444-50. [PMID: 24773559 DOI: 10.1089/neu.2013.3142] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wen-hao Wang
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Lian-shui Hu
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Hong Lin
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Jun Li
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Fei Luo
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Wei Huang
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Jun-ming Lin
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Gen-ping Cai
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Chang-chun Liu
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
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16
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Hu CF, Fan HC, Chang CF, Chen SJ. Current approaches to the treatment of head injury in children. Pediatr Neonatol 2013; 54:73-81. [PMID: 23590950 DOI: 10.1016/j.pedneo.2012.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 08/20/2012] [Accepted: 09/29/2012] [Indexed: 11/25/2022] Open
Abstract
Head trauma is one of the most challenging fields of traumatology and demands immediate attention and intervention by first-line clinicians. Symptoms can vary from victim to victim and according to the victim's age, leading to difficulties in making timely and accurate decisions at the point of care. In children, falls, accidents while playing, sports injuries, and abuse are the major causes of head trauma. Traffic accidents are the main cause of disability and death in adolescents and adults. Injury sites include facial bones, muscles, ligaments, vessels, joints, nerves, and focal or whole-brain injuries. Of particular importance are cranial and intracranial injuries. A closed injury occurs when the head suddenly and violently hits an object but the object does not break through the skull. A penetrating injury occurs when an object pierces the skull and affects the brain tissue. Early diagnosis and proper management are crucial to treat patients with potentially life-threatening head and neck trauma. In this review, we discuss the different cases of traumatic brain injury and summarize the current therapies and neuroprotective strategies as well as the related outcomes for children with traumatic brain injury.
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Affiliation(s)
- Chih-Fen Hu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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17
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Fatigba HO, Allodé AS, Savi de Tové KM, Mensah ED, Hodonou AM, Padonou J. The exploratory burr hole: indication and results at one departmental hospital of benin. ISRN SURGERY 2013; 2013:453907. [PMID: 23577270 PMCID: PMC3618947 DOI: 10.1155/2013/453907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 02/07/2013] [Indexed: 11/17/2022]
Abstract
Objective. The aim of this study was to describe the indications and results of exploratory burr hole performed at the Departmental Teaching Hospital of Borgou (Benin). Methods. It was a retrospective study performed from January 2008 to February 2011. It concerned patients with a closed traumatic brain injury (TBI) in which an exploratory burr hole was performed. The selection criteria were unilateral mydriasis associated with neurological deficits on the opposite side or the occurrence of a decreased consciousness associated with the appearance of a motor deficit after a lucid interval. Results. Amongst the 74 patients operated, 23 (31%) underwent an exploratory burr hole for which the average age was 24.8 ± 17.3 years. Sex ratio male/female was 3.6. TBI was due to road traffic accident (56.5%), a fall (26.1%), and an assault (17.4%). It was severe (47.8%), moderate (39.1%), and mild (13.1%). Mydriasis was observed in 69.6% of cases as well as neurological deficit in all patients. A lesion was observed in 15 (65.2%) cases. Conclusion. The exploratory burr hole seemed as an old practice, still no longer performed in full practice in Benin, and is a diagnosis and therapeutic approach. Better technical conditions would allow more relevant therapeutic options.
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Affiliation(s)
- Holden O. Fatigba
- Unit of Neurosurgery, Medicine School of Parakou University, P.O. Box 02, Borgou, Benin
| | | | | | - Emile D. Mensah
- Department of Surgery, Medicine School of Parakou University, Benin
| | | | - Jijoho Padonou
- Department of Surgery, Medicine School of Parakou University, Benin
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Gürer B, Kertmen H, Yilmaz ER, Sekerci Z. The surgical outcome of traumatic extra-axial hematomas causing brain herniation in children. Pediatr Neurosurg 2013; 49:215-22. [PMID: 25073982 DOI: 10.1159/000363193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/20/2014] [Indexed: 11/19/2022]
Abstract
AIM The aim of this study was to assess the surgical outcome and prognostic importance of clinical and radiological data from children operated on under emergency conditions due to an extra-axial hematoma causing brain herniation. METHODS This retrospective study included 25 children operated on due to herniated traumatic extra-axial hematomas from January 2000 to December 2010. RESULTS Of those 25 children, 17 (68%) were diagnosed with subdural hematoma (SDH), 7 (28%) with epidural hematoma (EDH) and only 1 patient (4%) suffered from both SDH and EDH. Overall mortality from a herniated extra-axial hematoma was 44%. The mortality rate for herniated SDH patients was 52.9%, and only 1 patient died from a herniated EDH (14.2%). Low Glasgow coma scale scores at admission, high postoperative intracranial pressure (ICP) values, longer intervals from trauma to surgery, longer durations of brain herniation, the presence of intraoperative brain swelling, larger and thicker hematomas and more displacement of the midline structures and obliteration of the basal cisterns were all correlated with mortality and an unfavorable outcome. CONCLUSIONS Brain herniation is a serious consequence of traumatic extra-axial hematomas in children, and approximately one third of these patients have the potential for a favorable outcome. We recommend postoperative ICP monitoring to predict outcome and early decompressive surgery when possible for promising results.
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Affiliation(s)
- Bora Gürer
- Neurosurgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, Ministry of Health, Istanbul, Turkey
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