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Zhu Q, von Spreckelsen N, Huang P, Zhou J, Pan Z, Liu J, Guo X, Xiong Y, Huang X, Hu W, Zheng F. Minimally invasive puncture with twist intraosseous drill needle combined with hematoma drainage in the treatment of acute epidural hematoma in pediatric patients: A technical note. Clin Neurol Neurosurg 2023; 226:107626. [PMID: 36773535 DOI: 10.1016/j.clineuro.2023.107626] [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: 12/21/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE The current neurosurgical intervention for treatment of acute epidural hematoma (AEDH) usually involves a craniotomy. Despite its effectiveness, open surgical decompression has several limitations. The twist intraosseous drill needle (TIDN) is considered a feasible alternative in adult patients with AEDH. AEDH treatment with TIDN in pediatric patients has not yet been described. The study aimed to report the efficacy and safety of minimally invasive puncture with a TIDN combined with hematoma drainage for the treatment of AEDH in pediatric patients. METHODS We retrospectively collected medical records of children with AEDH who underwent TIDN surgery at our institution from January 2017 to May 2021, and analyzed their clinical and imaging results. A detailed step-by-step surgical guide was provided. RESULTS Three pediatric patients with AEDH received TIDN treatment (including two males and one female; average age 7.66 years, range from 5 to 11 years). There were no intraoperative or postoperative complications in any case; 1 day after the operation, the AEDH was cleared in one of the three patients, and a slight hematoma remained in two patients. The remaining hematoma was evacuated after injecting urokinase into the hematoma cavity during indwelling drainage. CONCLUSION For pediatric patients with AEDH in a stable condition with a clear consciousness, TIDN puncture combined with hematoma drainage is safe, effective, and less invasive, and may present a viable surgical alternative option.
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Affiliation(s)
- Qiangbin Zhu
- Department of Neurosurgery, Hui'an County Hospital, Quanzhou, Fujian, China
| | - Niklas von Spreckelsen
- Department of Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
| | - Peikun Huang
- Department of Neurosurgery, Hui'an County Hospital, Quanzhou, Fujian, China
| | - Jianfeng Zhou
- Department of General Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Zhigang Pan
- Department of General Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Jinliang Liu
- Department of Neurosurgery, Hui'an County Hospital, Quanzhou, Fujian, China
| | - Xiumei Guo
- Department of General Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yu Xiong
- Department of General Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xinyue Huang
- Department of General Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Weipeng Hu
- Department of General Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
| | - Feng Zheng
- Department of General Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
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Krueger EM, Benveniste RJ, Taylor RR, Shah S, Moll J, Figueroa JM, Jagid JR. Neurologic Outcomes for Octogenarians Undergoing Emergent Surgery for Traumatic Acute Subdural Hematoma. World Neurosurg 2023; 171:e404-e411. [PMID: 36521754 DOI: 10.1016/j.wneu.2022.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Determining the appropriate surgical indications for obtunded octogenarians with traumatic acute subdural hematoma (aSDH) has been challenging. We sought to determine which easily available data would be useful adjuncts to assist in early and quick decision-making. METHODS We performed a single-center, retrospective review of patients aged ≥80 years with confirmed traumatic aSDH who had undergone emergent surgery. The clinical measurements included the Karnofsky performance scale score, Charlson comorbidity index, Glasgow coma scale (GCS), and abbreviated injury score. The radiographic measurements included the Rotterdam computed tomography score, aSDH thickness, midline shift, and optic nerve sheath diameter (ONSD). The neurologic outcomes were defined using the extended Glasgow outcome scale-extended (GOS-E) at hospital discharge and 3-month follow-up. The Pearson correlation coefficient was used to compare the ONSD with all clinical, radiographic, and outcome variables. Multivariate logistic regression was used to assess the relationship between the discharge and 3-month GOS-E scores between all clinical and radiographic variables. RESULTS A total of 17 patients met the inclusion criteria. The mean age was 82.5 ± 1.6 years (range, 80-85 years), and the mean GCS score was 11.2 ± 4.1 (range, 4-15). The mean discharge and 3-month GOS-E scores were 3.4 ± 2.6 (range, 1-8) and 2.3 ± 2.1 (range, 1-7), respectively. We found significant negative correlations between the ONSD and the GCS score (r = -0.62; P < 0.01) and the ONSD and discharge GOS-E score (r = -0.49; P = 0.05). Multivariate analysis revealed a significant association between the abbreviated injury score and the discharge GOS-E score (P = 0.05). CONCLUSIONS Octogenarians sustaining aSDH and requiring emergent surgery have poor outcomes. More data are needed to determine whether the ONSD can be a useful adjunct tool to predict the efficacy of emergent surgery.
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Affiliation(s)
- Evan M Krueger
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Ronald J Benveniste
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ruby R Taylor
- Univeristy of Miami Miller School of Medicine, Miami, Florida USA
| | - Sumedh Shah
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joshua Moll
- Univeristy of Miami Miller School of Medicine, Miami, Florida USA
| | - Javier M Figueroa
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan R Jagid
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Ryu HS, Hong JH, Kim YS, Kim TS, Joo SP. Minimally invasive fibrinolytic treatment and drainage in patients with acute subdural hemorrhage and underlying comorbidities. Medicine (Baltimore) 2022; 101:e31621. [PMID: 36401411 PMCID: PMC9678522 DOI: 10.1097/md.0000000000031621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The incidence of acute subdural hemorrhage (ASDH), which is often caused by head trauma, is steadily increasing due to an increase in the elderly population and the use of anticoagulants. Urgent surgical treatment is recommended if the patient has impaired consciousness, worsening neurological symptoms, or brain midline shift (MLS) due to large hematomas on brain computed tomography (CT). Although large craniotomy is traditionally recommended for ASDH removal, old age, comorbidities, and antiplatelet drugs are considered risk factors for surgical complications, many neurosurgeons hesitate to perform aggressive surgical procedures in these patients. In this study, we introduced a method that can quickly and effectively remove ASDH without general anesthesia. We retrospectively reviewed 11 cases of patients with ASDH who underwent hematoma drainage between June 2019 and December 2020. We measured the maximum subdural hematoma thickness and MLS on brain CT of patients and recorded the Glasgow Coma Scale scores before and after the surgical procedure. All patients had multiple comorbidities, and seven patients received anticoagulant or antiplatelet therapy. On initial brain CT, the median subdural hemorrhage thickness was 21.36 mm, median MLS was 10.09 mm, and mean volume of the subdural hematoma was 163.64 mL. The mean evacuation rate of the subdural hematoma after drainage was 83.57%. There was no rebleeding or operation-related infection during the aspiration procedure, and the median MLS correction after the procedure was 7.0 mm. Our treatment strategies can be a reliable, less invasive, and alternative treatment option for patients at high risk of complications due to general anesthesia or patients who are reluctant to undergo a large craniotomy due to a high bleeding tendency.
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Affiliation(s)
- Han Seung Ryu
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Jong Hwan Hong
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - You-Sub Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Tae-Sun Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
- *Correspondence: Sung-Pil Joo, Department of Neurosurgery, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju 501-757, Republic of Korea (e-mail: ; )
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Miyazaki A, Nakagawa T, Matsuura J, Takesue Y, Otsuka T. Surgical safety criteria for burr hole surgery with urokinase in patients with acute subdural hematoma: Retrospective comparison between burr hole surgery and craniotomy. Surg Neurol Int 2021; 12:574. [PMID: 34877060 PMCID: PMC8645488 DOI: 10.25259/sni_388_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/04/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Acute subdural hematoma (ASDH) is a common disease and craniotomy is the first choice for removing hematoma. However, patients for whom craniotomy or general anesthesia is contraindicated are increasing due to population aging. In our department, we perform burr hole surgery under local anesthesia with urokinase administration for such patients. We compared the patient background and outcomes between burr hole surgery and craniotomy to investigate the surgical safety criteria for burr hole surgery. Methods: We reviewed 24 patients who underwent burr hole surgery and 33 patients who underwent craniotomy between January 2010 and April 2020 retrospectively. Results: The median age of the burr hole surgery group was older (P = 0.01) and they had multiple pre-existing conditions. Compared with the craniotomy group, neurological deficits and CT findings were minor in the burr hole surgery group, whereas the maximum hematoma thickness was not significantly different. The hematoma was excreted after a total of 54,000 IU of urokinase was administered for a median of 3 days. The Glasgow Coma Scale score improved in all patients in the burr hole surgery group and there were no deaths. Age, especially over 65 y.o., (OR 1.16, 95% CI 1.04–1.30) and the absence of basal cistern disappearance (OR 0.04, 95% CI 0.004–0.39) were significant factors. Conclusion: Burr hole surgery was performed safely in all patients based on the age, especially older than 65 y.o., and the absence of basal cistern disappearance. ASDH in the elderly is increasing and less invasive burr hole surgery with urokinase is suitable for the super-aging society.
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Affiliation(s)
- Airi Miyazaki
- Department of Neurosurgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Takashi Nakagawa
- Department of Neurosurgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Jin Matsuura
- Department of Neurosurgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Yoshihiro Takesue
- Department of Neurosurgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Tadahiro Otsuka
- Department of Neurosurgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
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In Reply to the Letter to the Editor Regarding "Subdural Catheter Injection of Tissue Plasminogen Activator for Residual Hematoma Post Drainage of Acute-on-Chronic Subdural Hematoma: Novel Case Report of 2 Patients". World Neurosurg 2020; 134:681. [PMID: 32059288 DOI: 10.1016/j.wneu.2019.11.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 11/23/2022]
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Lam J, Lee DJ, Oladunjoye A. Subdural Catheter Injection of Tissue Plasminogen Activator for Residual Hematoma Post Drainage of Acute-on-Chronic Subdural Hematoma: Novel Case Report of 2 Patients. World Neurosurg 2020; 133:266-270. [DOI: 10.1016/j.wneu.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/16/2022]
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