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Zeng M, Li Z, Xia C, Cheng X, Wang Y, Wang F. Postoperative epidural hematoma as a rare complication after intracranial tumor resection: a case series report and causes analysis. Chin Neurosurg J 2024; 10:7. [PMID: 38424654 PMCID: PMC10905794 DOI: 10.1186/s41016-024-00359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 02/18/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND To review the treatment and the causes of postoperative epidural hematoma (PEDH) after intracranial tumor resection. METHOD A retrospective case study was conducted to examine a series of patients who developed PEDH as a complication following intracranial tumor resection between January 2016 and June 2021. The study collected data from hospital charts, including clinical status at admission, imaging results, histopathologic findings, surgical management, complications, and outcomes. Causes of PEDH were evaluated through a review of operative notes and discussions with the surgical team. RESULTS Twenty-five patients (10 males, 15 females; median age 42 years, range 11-61 years; median medical history 27 months, range 1-96 months) were enrolled in the study. Regarding tumor location, 16 cases exhibited supratentorial brain tumors, 4 cases had infratentorial brain tumors, 2 cases of tumors occurred in the petroclival region, 2 cases in the peritorcular region, and 1 case in the pineal region. Four of these cases were complicated with supratentorial hydrocephalus. The 25 cases in this study were classified into four types based on location. Type 1 refers to EDHs that occur at the adjacent site of the operative field without involvement of the surgical area. Type 2 includes hematomas that occur at the adjacent site of the surgical area and the surgical area. Type 3 includes EDHs that occur in distant areas, and type 4 involves EDHs in the surgical field. The numbers of cases of types 1, 2, 3, and 4 PEDHs were 16, 2, 3, and 4 cases, respectively. Most PEDHs were associated with reduced ICP after craniotomy due to intracranial tumor resection and substantial loss of CSF. All patients achieved satisfactory outcomes after hematoma evacuation. CONCLUSION The decrease in ICP resulting from intracranial tumor resection and CSF loss might lead to PEDHs. By employing optimized surgical techniques and meticulous patient management to prevent rapid decreases in ICP and dural detachment, we can potentially lower the incidence of PEDHs. Additionally, prompt evacuation of hematomas can contribute to positive outcomes.
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Affiliation(s)
- Minghui Zeng
- Department of Neurosurgery, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230036, Anhui, China.
| | - Zhijin Li
- Department of Neurosurgery, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230036, Anhui, China
| | - Chunsheng Xia
- Department of Neurosurgery, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230036, Anhui, China
| | - Xufeng Cheng
- Department of Neurosurgery, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230036, Anhui, China
| | - Yehan Wang
- Department of Neurosurgery, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230036, Anhui, China
| | - Fei Wang
- Department of Neurosurgery, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Science and Medicine, University of Science and Technology of China, Hefei, 230036, Anhui, China
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Laaidi A, Rafiq A, Tahrir Y, Hilmani S, Lakhdar A. Contralateral epidural hematoma after decompressive surgery: Case report and systematic literature review. Ann Med Surg (Lond) 2022; 74:103233. [PMID: 35145655 PMCID: PMC8818896 DOI: 10.1016/j.amsu.2021.103233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Abderrahmane Rafiq
- Corresponding author. Neurosurgery department, University Hospital Center IBN ROCHD, 1, Rue des Hôpitaux, Casablanca, Morocco.
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Pillai MK, Kariyattil R, Govindaraju V, Kochummen K, Kumar R. Extradural Hematoma Following Decompressive Craniectomy for Acute Subdural Hematoma: Two Case Reports Illustrating Different Mechanisms. Asian J Neurosurg 2018; 13:1213-1215. [PMID: 30459897 PMCID: PMC6208202 DOI: 10.4103/ajns.ajns_87_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The occurrence of extradural hematoma (EDH) after decompressive craniectomy (DC) for traumatic brain injury is uncommon. We report two cases, one developing ipsilateral EDH and another developing contralateral simultaneous EDH and subdural hematoma after DC. The strategies to anticipate the occurrence of such concurrent hematomas (CH) are highlighted. We propose a subclassification of CH into “immediate” and “delayed,” based on their difference in clinical presentation, image findings, pathogenesis, and surgical management.
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Affiliation(s)
- Mahesh Krishna Pillai
- Department of Neurosurgery, Sultan Qaboos University Hospital, Al Khaud, Muscat, Oman
| | - Rajeev Kariyattil
- Department of Neurosurgery, Sultan Qaboos University Hospital, Al Khaud, Muscat, Oman
| | - Venkatesh Govindaraju
- Department of Neurosurgery, Sultan Qaboos University Hospital, Al Khaud, Muscat, Oman
| | - Koshy Kochummen
- Department of Neurosurgery, Sultan Qaboos University Hospital, Al Khaud, Muscat, Oman
| | - Rajinder Kumar
- Department of Neurosurgery, Sultan Qaboos University Hospital, Al Khaud, Muscat, Oman
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Wu R, Shi J, Cao J, Mao Y, Dong B. Two occurrences of delayed epidural hematoma in different areas following decompressive craniectomy for acute subdural hematoma in a single patient: a case report. BMC Surg 2017; 17:123. [PMID: 29202748 PMCID: PMC5715532 DOI: 10.1186/s12893-017-0303-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 11/09/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Delayed epidural hematoma (DEH) following evacuation of traumatic acute subdural hematoma (ASDH) or acute epidural hematoma (EDH) is a rare but devastating complication, especially when it occurs sequentially in a single patient. CASE PRESENTATION A 19-year-old man who developed contralateral DEH following craniotomy for evacuation of a traumatic right-side ASDH and then developed a left-side DEH of the posterior cranial fossa after craniotomy for evacuation of the contralateral DEH. He was immediately returned to the operating room for additional surgeries and his neurological outcome was satisfactory. CONCLUSIONS Although DEH occurring after evacuation of ASDH or acute EDH is a rare event, timely recognition is critical to prognosis.
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Affiliation(s)
- Ruhong Wu
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
| | - Jia Shi
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
| | - Jiachao Cao
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
| | - Yumin Mao
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
| | - Bo Dong
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
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Moussa WMM, Khedr WM, Elwany AH. Prognostic significance of hematoma thickness to midline shift ratio in patients with acute intracranial subdural hematoma: a retrospective study. Neurosurg Rev 2017; 41:483-488. [DOI: 10.1007/s10143-017-0873-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
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Wang K, Xue Y, Chen X, Zhou B, Lou M. Uncorrected traumatic coagulopathy is associated with severe brain swelling during decompressive surgery to evacuate a supratentorial intradural mass lesion in patients with traumatic brain injury. Neurol Res 2013; 35:642-8. [PMID: 23561830 DOI: 10.1179/1743132813y.0000000187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Ke Wang
- Department of NeurosurgeryShanghai Tenth People’s Hospital, Tongji University, China
| | - Yajun Xue
- Department of NeurosurgeryShanghai Tenth People’s Hospital, Tongji University, China
| | - Xianzhen Chen
- Department of NeurosurgeryShanghai Tenth People’s Hospital, Tongji University, China
| | - Bin Zhou
- Department of NeurosurgeryShanghai Tenth People’s Hospital, Tongji University, China
| | - Meiqing Lou
- Department of NeurosurgeryShanghai Tenth People’s Hospital, Tongji University, China
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Ma J, Li H, Cheng L, Lin S. Vaccum drainage system application in the management of operation-related non-regional epidural hematoma. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2013; 7:7. [PMID: 23842198 PMCID: PMC3751531 DOI: 10.1186/1750-1164-7-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 07/01/2013] [Indexed: 11/26/2022]
Abstract
Background Epidural intracranial hematoma is one of the most common complications of surgeries for intracranial tumors. The non-regional epidural hematoma is related to severe fluctuation of the intracranial pressure during the operation. The traditional management of hematoma evacuation through craniotomy is time-consuming and may aggravate intracranial pressure imbalance, which causes further complications. We designed a method using vaccum epidural drainage system, and tried to evaluate advantage and the disadvantage of this new technique. Methods Seven patients of intracranial tumors were selected. All of the patients received tumor resection and intra-operative non-regional epidural hematoma was confirmed through intra-operative ultrasound or CT scan. The vaccum drainage system was applied. Another ten patients who received craniotomy for intra-operative non-regional epidural hematoma evacuation were selected as comparison. Regular tests, like serial CT scan, were performed afterward to evaluate the effectiveness and to help deciding when to remove the drainage system. Results The vaccum drainage method was effective in epidual hemotoma clearance and prevented recurrent epidural hemorrhage. The drainage systems were removed within 4 days. All of the patients recovered well. No complications related to the drainage system were observed. Conclusions Compared to the traditional craniotomy, the new method of epidural hemoatoma management using vaccum epidural drainage system proved to be as effective in hematoma clearance, and was less-invasive and easier to perform, with less complication, shorter hospitalization, less economic burden, and better prognosis.
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Affiliation(s)
- Jun Ma
- Department of Neurosurgery, Capital Medical University-Beijing Tiantan Hospital, Beijing, China
| | - Huan Li
- Department of Neurosurgery, Capital Medical University-Beijing Tiantan Hospital, Beijing, China
| | - Linggang Cheng
- Department of Neurosurgery, Capital Medical University-Beijing Tiantan Hospital, Beijing, China
| | - Song Lin
- Department of Neurosurgery, Capital Medical University-Beijing Tiantan Hospital, Beijing, China ; Beijing Tiantan Hospital, Dongcheng District, Beijing, China
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Contralateral extraaxial hematomas after urgent neurosurgery of a mass lesion in patients with traumatic brain injury. Eur J Trauma Emerg Surg 2013; 39:277-83. [PMID: 26815234 DOI: 10.1007/s00068-013-0268-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The development of a contralateral extraaxial hematoma has repeatedly been described in small series and descriptive studies. However, the evidence available to date is limited. OBJECTIVES To evaluate the incidence and risk factors leading to the development of a contralateral extraaxial hematoma and to describe the characteristics of cases. METHODS A retrospective cohort study with prospective data collection was undertaken. All patients admitted to an intensive care unit (ICU) from 2006 to 2010 were studied. The inclusion criteria were as follows: severe trauma [Injury Severity Score (ISS ≥ 16)], neurosurgery (NeuroSx) in the first 24 h. The following were excluded: subacute/chronic subdural hematomas, first bilateral NeuroSx. Cases were those who required immediate contralateral NeuroSx after the first NeuroSx due to the occurrence of a new extraaxial injury or significant growth of a previous one. Controls were those patients those who did not require second NeuroSx or who required reoperation due to ipsilateral lesions. The variables considered were: demographics, neurological assessment, traumatic injuries and severity, image and surgical findings, clinical course, and outcome. Statistics analysis comprised descriptive, inferential, and multivariate analysis by logistic regression. RESULTS A total of 120 patients were included, among which there were 11 cases (incidence 9.2 %). The cases showed a significantly higher frequency of coma or severe traumatic brain injury (TBI) at admission, contralateral injury and contralateral skull fracture in the preoperative computed tomography (CT) scan, as well as decompressive craniectomy. There were no significant differences in the severity scores, clinical course, or outcomes. The presence of contralateral fracture was identified as an independent risk factor [relative risk (RR) 47.9, 95 % confidence interval (CI) 5.2-443]. CONCLUSIONS Contralateral extraaxial hematoma is a rare entity, although it has a high mortality rate. Therefore, it requires a high index of suspicion, especially in patients with severe TBI, with minimal contralateral injury and mainly with contralateral skull fracture on the initial CT scan.
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Wen L, Li QC, Wang SC, Lin Y, Li G, Gong JB, Wang F, Su L, Zhan RY, Yang XF. Contralateral haematoma secondary to decompressive craniectomy performed for severe head trauma: A descriptive study of 15 cases. Brain Inj 2013; 27:286-92. [DOI: 10.3109/02699052.2012.743180] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shen J, Pan JW, Fan ZX, Zhou YQ, Chen Z, Zhan RY. Surgery for contralateral acute epidural hematoma following acute subdural hematoma evacuation: five new cases and a short literature review. Acta Neurochir (Wien) 2013; 155:335-41. [PMID: 23238942 DOI: 10.1007/s00701-012-1569-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 11/16/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The occurrence of a contralateral acute epidural hematoma (AEDH) following removal of an acute subdural hematoma (ASDH) is a rare but nearly devastating postoperative complication. Here, we describe a series of five patients with contralateral AEDH and provide a review of the literature to elucidate the characteristics and improve management of these patients. METHODS A total of 386 patients underwent ASDH evacuations in our hospital between August 2008 and July 2011. Five of these patients (1.3 %) developed AEDH that required surgery. Thirty-two additional patients were identified by a search of the PubMed database. Clinical features, surgical treatment, and outcomes (scored by Glasgow outcome scale, GOS) of the collective 37 AEDH cases were analyzed retrospectively. RESULTS Contralateral AEDH after ASDH evacuation occurred in 27 males (73 %) and 10 females (27 %) (mean age: 35.9 ± 14.2 years). Twenty-six patients (70 %) had unfavorable outcomes (GOS 1-3), and 11 patients (30 %) had favorable outcomes (GOS 4-5). Contralateral skull fractures and intraoperative acute brain swelling occurred in 30 (81 %) and 28 (76 %) patients, respectively. The preoperative Glasgow coma score (GCS) was significantly associated with outcome (p < 0.05). CONCLUSIONS Lower preoperative GCS score is an independent risk factor for prognosis of contralateral AEDH after ASDH. Postoperative management should include assessment of AEDH in patients treated for contralateral skull fractures and who experienced intraoperative acute brain swelling. We recommend early decompression with a burr-hole craniotomy, immediately followed by a decompressive craniectomy. This strategy provides gradual decompression, while advancing the initial surgical time and preventing the suddle decreased tamponade effect. As such, it may help decrease the risk of contralateral AEDH associated with decompression.
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Takeuchi S, Takasato Y, Suzuki G, Maeda T, Masaoka H, Hayakawa T, Otani N, Yatsushige H, Shigeta K, Momose T. Computed tomography after decompressive craniectomy for head injury. ACTA NEUROCHIRURGICA. SUPPLEMENT 2013; 118:235-237. [PMID: 23564139 DOI: 10.1007/978-3-7091-1434-6_44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
New findings (NF) on postoperative CTs are -occasionally found in patients who undergo surgery for traumatic brain injury (TBI). We conducted a retrospective -registry-based review of the care of 102 patients who underwent decompressive craniectomy (DC) for TBI to investigate the prognostic factors of new findings on CT early after -surgery. Of the 102 patients, the mean age was 50 years and 69.6 % were male. The overall survival was 72.5 %. The primary indication for DC included subdural hematoma in 72 (70.6 %), epidural hematoma in 17 (16.7 %), and intraparenchymal contusion in 13 (12.7 %). New findings on postoperative CTs were observed in 26 patients (25.5 %). The univariate analysis showed that a GCS score ≤8 (P = 0.012) and the absence of a basal cistern (P = 0.012) were significantly associated with NF on postoperative CT. The logistic regression analysis demonstrated that the GCS score ≤8 (P = 0.041; OR, 3.0; 95 % CI, 1.048-8.517) was the only significant factor. TBI patients with a low GCS score who underwent DC should undergo additional CT evaluations immediately after surgery.
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Affiliation(s)
- Satoru Takeuchi
- Department of Neurosurgery, National Defense Medical College, Saitama, Japan.
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Timofeev I, Santarius T, Kolias AG, Hutchinson PJA. Decompressive craniectomy - operative technique and perioperative care. Adv Tech Stand Neurosurg 2012; 38:115-136. [PMID: 22592414 DOI: 10.1007/978-3-7091-0676-1_6] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
With improvements in neurocritical care advanced measures of treating raised intracranial pressure (ICP) are more frequently utilised. Decompressive craniectomy is an effective ICP-lowering procedure; however its benefits are maximised with optimal surgical technique and perioperative care, as well as by paying attention to possible complications. This article focuses on the current indications and rationale for decompressive craniectomy, and the surgical technique of bifrontal and unilateral decompression. The key surgical points include a large craniectomy window and opening of the dura, leaving it unsutured or performing a wide non-constricting duroplasty. Perioperative care and possible complications are also discussed.
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Affiliation(s)
- I Timofeev
- Academic Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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15
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Therapeutic Targeting of Astrocytes After Traumatic Brain Injury. Transl Stroke Res 2011; 2:633-42. [DOI: 10.1007/s12975-011-0129-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 10/21/2011] [Accepted: 10/25/2011] [Indexed: 10/15/2022]
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Roth J, Galeano E, Milla S, Hartmannsgruber MW, Weiner HL. Multiple epidural hematomas and hemodynamic collapse caused by a subgaleal drain and suction-induced intracranial hypotension: case report. Neurosurgery 2011; 68:E271-5; discussion E276. [PMID: 21099705 DOI: 10.1227/neu.0b013e3181fe6165] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Subgaleal drains are commonly used in neurosurgery. Rare complications attributed to these drains have been described. We present a rare complication of hemodynamic collapse and multiple epidural hematomas attributed to intracranial hypotension induced by a subgaleal drain connected to suction during wound closure. CLINICAL PRESENTATION A 3.5-year-old boy underwent an uneventful occipital lobectomy and titanium mesh cranioplasty for resection of a recurrent choroid plexus carcinoma. The child had undergone 2 uneventful previous resections and cranial irradiation. During skin closure, a subgaleal drain was connected to suction to keep the surgical bed dry. Immediately after completion of the subgaleal layer closure, there was an acute hemodynamic collapse, accompanied by bradycardia and a drop in the hematocrit. After successful resuscitation, the child underwent a brain computed tomography scan that showed a large bifrontal epidural hematoma and multiple additional small epidural hematomas. The large hematoma was surgically evacuated, and the child had an uneventful recovery. CONCLUSION Acute negative intracranial hypotension may cause bradycardia, epidural hematomas, and hemodynamic collapse. Subgaleal drains should not be connected to suction systems, and care should be taken when these drains are connected to vacuum bulbs in high-risk cases such as after cranial irradiation, large resections, and mesh cranioplasties.
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Affiliation(s)
- Jonathan Roth
- Department of Neurosurgery, Division of Pediatric Neurosurgery, NYU Langone Medical Center, New York, New York 10016, USA.
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Contralateral Acute Subdural Hematoma After Surgical Evacuation of Acute Subdural Hematoma. ACTA ACUST UNITED AC 2010; 68:E11-2. [DOI: 10.1097/ta.0b013e31811eaaf5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mohindra S, Mukherjee KK, Gupta R, Chhabra R, Gupta SK, Khosla VK. Decompressive surgery for acute subdural haematoma leading to contralateral extradural haematoma: a report of two casesand review of literature. Br J Neurosurg 2009; 19:490-4. [PMID: 16574562 DOI: 10.1080/02688690500495216] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Development of a contralateral epidural haematoma during or immediately after cranial surgery is a well-described entity. However, in a case of acute subdural haematoma where the brain is usually tense, postoperative development of contralateral extradural haematoma is uncommon. We report two cases of contralateral extradural haematoma after decompressive surgery for acute subdural haematoma. We recommend routine postoperative CT immediately after cranial surgery for head trauma. This would help in timely detection and treatment of such a complication.
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Affiliation(s)
- S Mohindra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Decompressive craniectomy is widely used to treat intracranial hypertension following traumatic brain injury (TBI). Two randomized trials are currently underway to further evaluate the effectiveness of decompressive craniectomy for TBI. Complications of this procedure have major ramifications on the risk-benefit balance in decision-making during evaluation of potential surgical candidates. To further evaluate the complications of decompressive craniectomy, a review of the literature was performed following a detailed search of PubMed between 1980 and 2009. The author restricted her study to literature pertaining to decompressive craniectomy for patients with TBI. An understanding of the pathophysiological events that accompany removal of a large piece of skull bone provides a foundation for understanding many of the complications associated with decompressive craniectomy. The author determined that decompressive craniectomy is not a simple, straightforward operation without adverse effects. Rather, numerous complications may arise, and they do so in a sequential fashion at specific time points following surgical decompression. Expansion of contusions, new subdural and epidural hematomas contralateral to the decompressed hemisphere, and external cerebral herniation typify the early perioperative complications of decompressive craniectomy for TBI. Within the 1st week following decompression, CSF circulation derangements manifest commonly as subdural hygromas. Paradoxical herniation following lumbar puncture in the setting of a large skull defect is a rare, potentially fatal complication that can be prevented and treated if recognized early. During the later phases of recovery, patients may develop a new cognitive, neurological, or psychological deficit termed syndrome of the trephined. In the longer term, a persistent vegetative state is the most devastating of outcomes of decompressive craniectomy. The risk of complications following decompressive craniectomy is weighed against the life-threatening circumstances under which this surgery is performed. Ongoing trials will define whether this balance supports surgical decompression as a first-line treatment for TBI.
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Stiver SI, Wintermark M, Manley GT. Reversible monoparesis following decompressive hemicraniectomy for traumatic brain injury. J Neurosurg 2008; 109:245-54. [DOI: 10.3171/jns/2008/109/8/0245] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The “syndrome of the trephined” is an uncommon and poorly understood disorder of delayed neurological deficit following craniectomy. From the authors' extensive experience with decompressive hemicraniectomy for traumatic brain injury (TBI), they have encountered a number of patients who developed delayed motor deficits, also called “motor trephine syndrome,” and reversal of the weakness following cranioplasty repair. The authors set out to study motor function systematically in this patient population to define the incidence, contributing factors, and outcome of patients with motor trephine syndrome.
Methods
The authors evaluated patient demographics, injury characteristics, detailed motor examinations, and CT scans in 38 patients with long-term follow-up after decompressive hemicraniectomy for TBI.
Results
Ten patients (26%) experienced delayed contralateral upper-extremity weakness, beginning 4.9 ± 0.4 months (mean ± standard error) after decompressive hemicraniectomy. Motor deficits improved markedly within 72 hours of cranioplasty repair, and all patients recovered full motor function. The CT perfusion scans, performed in 2 patients, demonstrated improvements in cerebral blood flow commensurate with resolution of cerebrospinal fluid flow disturbances on CT scanning and return of motor strength. Comparisons between 10 patients with and 20 patients (53%) without delayed motor deficits identified 3 factors—ipsilateral contusions, abnormal cerebrospinal fluid circulation, and longer intervals to cranioplasty repair—to be strongly associated with delayed, reversible monoparesis following decompressive hemicraniectomy.
Conclusions
Delayed, reversible monoparesis, also called motor trephine syndrome, is common following decompressive hemicraniectomy for TBI. The results of this study suggest that close follow-up of motor strength with early cranioplasty repair may prevent delayed motor complications of decompressive hemicraniectomy.
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Affiliation(s)
| | - Max Wintermark
- 2Radiology, School of Medicine, University of California, San Francisco, California
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Furukawa M, Kinoshita K, Ebihara T, Sakurai A, Noda A, Kitahata Y, Utagawa A, Moriya T, Okuno K, Tanjoh K. Clinical characteristics of postoperative contralateral intracranial hematoma after traumatic brain injury. ACTA NEUROCHIRURGICA. SUPPLEMENT 2006; 96:48-50. [PMID: 16671423 DOI: 10.1007/3-211-30714-1_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVES To investigate the clinical characteristics of contralateral intracranial hematoma (ICH) after traumatic brain injury. METHODS The subjects included 149 patients with traumatic ICH treated by hematoma evacuation. The patients were retrospectively divided into a bilateral ICH (B-ICH) group and unilateral ICH (U-ICH) group after craniotomy using brain CT scans for comparison of the following parameters: complicated expanded brain bulk from the cranial window, hypotension during craniotomy, and outcome. RESULTS Post-craniotomy brain CT scans revealed U-ICH in 106 patients and B-ICH in 43 patients. Average Glasgow Coma Scale on arrival did not differ between the groups, but a higher proportion of patients in the B-ICH group deteriorated after admission (p = 0.02). The B-ICH patients also exhibited a significantly higher rate of expanded brain bulk from the cranial window (p < 0.05). No significant difference was observed between the groups with hypotension during craniotomy. The B-ICH group exhibited a lower rate of favorable outcome (p < 0.05) and higher mortality (p < 0.05). CONCLUSION The B-ICH patients had a worse outcome than the U-ICH patients. Contralateral ICH was difficult to forecast based on pre- and intraoperative clinical conditions. Subdural hematoma or contusional ICH was frequently observed as a contralateral ICH.
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Affiliation(s)
- M Furukawa
- Department of Emergency and Critical Care Medicine, Nihon University School of Medicine, Tokyo, Japan.
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