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Beniwal HK, Reddy MS, Rao GP, Srikrishnaditya M, Beniwal A. Prognostic Value of Swirl Sign in Acute Epidural Hemorrhage. Asian J Neurosurg 2022; 17:584-587. [PMID: 36644411 PMCID: PMC9832927 DOI: 10.4103/ajns.ajns_68_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective The purpose of this study is to analyze and evaluate the incidence, prognostic value, and impact of swirl sign on the outcome of patients who underwent surgical treatment for epidural hematoma. Materials and Methods A retrospective analytical study on 307 acute epidural hematoma (AEDH) patients with and without swirl sign was conducted at our hospital between 2015 and 2019. All the patients in this study were treated initially as per the protocols of advanced trauma life support and surgically treated by craniotomy and evacuation of epidural hematoma. Patients with other concomitant intracerebral injuries such as subdural hematoma and contusion and those who were managed conservatively were excluded from the study. Various factors such as age, sex, mechanism of injury, Glasgow Coma Scale (GCS) score at admission, time from injury to surgery, preoperative mydriasis, location of bleed, midline shift, location of fracture, volume of hematoma, duration of stay in the hospital, and GCS score at discharge were taken into consideration and compared in between patients with and without swirl sign. Outcomes were assessed at the end of 6 months using the Glasgow Outcome Scale. Results Of the 307 patients who were operated for epidural hemorrhage, 92 had swirl sign (29.96%) and the rest had no swirl sign. Univariate analysis revealed a significant correlation between the presence of swirl sign and age, preoperative mydriasis, and time from injury to surgery. The patients with the swirl sign had an unfavorable outcome at the end of 6 months which was statistically significant. Conclusion It can be concluded that those patients with swirl sign in AEDH had an unfavorable outcome compared to those without swirl sign. Therefore, aggressive treatment and early surgery play an important role in the outcomes of the patients.
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Affiliation(s)
- Hemant Kumar Beniwal
- Department of Neurosurgery, Gandhi Medical College and Hospital, Mahbubnagar, Telangana,Address for correspondence Hemant Kumar Beniwal Department of Neurosurgery, 4th Floor, Gandhi Medical College and HospitalPadma Rao Nagar, Secunderabad, 500003, TelanganaIndia
| | | | - Golapudi Prakash Rao
- Department of Neurosurgery, Gandhi Medical College and Hospital, Mahbubnagar, Telangana
| | - Manne Srikrishnaditya
- Department of Neurosurgery, Gandhi Medical College and Hospital, Mahbubnagar, Telangana
| | - Anisha Beniwal
- Department of Critical Care Medicine, Max Hospital, Saket, New Delhi India
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Yang C, Hui J, Xie L, Feng J, Jiang J. Comparative effectiveness of different surgical procedures for traumatic acute epidural haematoma: study protocol for Prospective, Observational Real-world Treatments of AEDH in Large-scale Surgical Cases (PORTALS-AEDH). BMJ Open 2022; 12:e051247. [PMID: 35264341 PMCID: PMC8915281 DOI: 10.1136/bmjopen-2021-051247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Controversy and variation exist in surgical management for acute epidural haematoma (AEDH). Although craniotomy for AEDH is conventionally employed, no specific evaluation on the necessity of decompressive craniectomy (DC) followed by AEDH evacuation has been performed. METHODS AND ANALYSIS This is a multicentre prospective, phase III observational study that evaluates different surgical managements for the AEDH. Patients of both genders, aged 18-65 years, presenting to the emergency room with a clinical and radiological diagnosis of AEDH, complying with other inclusion and exclusion criteria, are enrolled. Clinical information, including diagnosis of AEDH, radiological information, treatment procedures and follow-up data of 1, 3 and 6 months post-injury, is collected on 2000 eligible patients among 263 hospitals in China. Recruitment for the study started in April 2021, and inclusion will be continued until the sample size is obtained, expected is an inclusion period of 24 months. The interventions of concern are surgical treatments for AEDH, including craniotomy and DC. The primary outcome is the Glasgow Outcome Score-Extended 6 months post-injury. Secondary outcomes include the incidence of postoperative cerebral infarction, the incidence of additional craniocerebral surgery and other evaluation indicators within 6 months post-injury. ETHICS AND DISSEMINATION The study protocol has been approved by the ethics committee and institutional review board of Renji Hospital, School of Medicine, Shanghai Jiao Tong University. All study investigators strictly follow the Declaration of Helsinki and Human Biomedical Research Ethical Issues. Signed written informed consent will be obtained from all enrolled patients. The trial results will be disseminated through academic conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04229966.
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Affiliation(s)
- Chun Yang
- Brain Injury Center, Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Institute of Head Trauma, Shanghai, China
| | - Jiyuan Hui
- Brain Injury Center, Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Institute of Head Trauma, Shanghai, China
| | - Li Xie
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junfeng Feng
- Brain Injury Center, Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Institute of Head Trauma, Shanghai, China
| | - Jiyao Jiang
- Brain Injury Center, Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Institute of Head Trauma, Shanghai, China
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Subdural and epidural hematoma occurrence in relation to the head impact site: An autopsy study. J Forensic Leg Med 2021; 85:102283. [PMID: 34794084 DOI: 10.1016/j.jflm.2021.102283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/07/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022]
Abstract
Blunt head injury is a major public health and socioeconomic problem causing death and disability particularly among the young population throughout the world. The purpose of the present study was to evaluate if the impact site is correlated with the subdural and epidural hematoma occurrence. A retrospective analysis of consecutive autopsy cases submitted to our Department during a 5-year period was performed. The basic criterion for inclusion in the study was death due to blunt head injury. The recorded variables included the circumstances of death, the existence, and location of head injuries, the primary impact site, age, gender, and toxicological results. A total number of 683 fatal head injury cases was recorded, with most of them being male (74.1%). In 424 cases (62.1%) fatal head injuries were due to road traffic accidents. Fall (from height or on the ground) was the cause of death in 220 (32.2%) cases followed by inflicted impact-assault in 26 (3.8%) cases. A subdural hematoma was found more frequently (26.9%) than epidural (5.0%). Epidural hematomas were found only under the primary impact site, whereas subdural hematomas were coup, contrecoup, or bilateral. An epidural hematoma was found to be almost 5 times more frequent in cases in which a subdural hematoma was present. A higher proportion of subdural, as well as epidural hematoma, was found when the site of impact was the temporal region, followed by the parietal one. Sex did not exert any influence on the probability of subdural and epidural hematoma, whereas for age, a 10% increase in the probability of subdural hematoma occurrence was observed with 10-year age increase.
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Ludwig HC, Dreha-Kulaczewski S, Bock HC. Neurofluids-Deep inspiration, cilia and preloading of the astrocytic network. J Neurosci Res 2021; 99:2804-2821. [PMID: 34323313 DOI: 10.1002/jnr.24935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/15/2021] [Accepted: 07/13/2021] [Indexed: 01/20/2023]
Abstract
With the advent of real-time MRI, the motion and passage of cerebrospinal fluid can be visualized without gating and exclusion of low-frequency waves. This imaging modality gives insights into low-volume, rapidly oscillating cardiac-driven movement as well as sustained, high-volume, slowly oscillating inspiration-driven movement. Inspiration means a spontaneous or artificial increase in the intrathoracic dimensions independent of body position. Alterations in thoracic diameter enable the thoracic and spinal epidural venous compartments to be emptied and filled, producing an upward surge of cerebrospinal fluid inside the spine during inspiration; this surge counterbalances the downward pooling of venous blood toward the heart. Real-time MRI, as a macroscale in vivo observation method, could expand our knowledge of neurofluid dynamics, including how astrocytic fluid preloading is adjusted and how brain buoyancy and turgor are maintained in different postures and zero gravity. Along with these macroscale findings, new microscale insights into aquaporin-mediated fluid transfer, its sensing by cilia, and its tuning by nitric oxide will be reviewed. By incorporating clinical knowledge spanning several disciplines, certain disorders-congenital hydrocephalus with Chiari malformation, idiopathic intracranial hypertension, and adult idiopathic hydrocephalus-are interpreted and reviewed according to current concepts, from the basics of the interrelated systems to their pathology.
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Affiliation(s)
- Hans C Ludwig
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Steffi Dreha-Kulaczewski
- Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Hans C Bock
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
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Ye H, Gao F, Yin Y, Guo D, Zhao P, Lu Y, Wang X, Bai J, Cao K, Song Q, Zhang H, Chen W, Guo X, Xia J. Precise diagnosis of intracranial hemorrhage and subtypes using a three-dimensional joint convolutional and recurrent neural network. Eur Radiol 2019; 29:6191-6201. [PMID: 31041565 PMCID: PMC6795911 DOI: 10.1007/s00330-019-06163-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/18/2019] [Accepted: 03/14/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate the performance of a novel three-dimensional (3D) joint convolutional and recurrent neural network (CNN-RNN) for the detection of intracranial hemorrhage (ICH) and its five subtypes (cerebral parenchymal, intraventricular, subdural, epidural, and subarachnoid) in non-contrast head CT. METHODS A total of 2836 subjects (ICH/normal, 1836/1000) from three institutions were included in this ethically approved retrospective study, with a total of 76,621 slices from non-contrast head CT scans. ICH and its five subtypes were annotated by three independent experienced radiologists, with majority voting as reference standard for both the subject level and the slice level. Ninety percent of data was used for training and validation, and the rest 10% for final evaluation. A joint CNN-RNN classification framework was proposed, with the flexibility to train when subject-level or slice-level labels are available. The predictions were compared with the interpretations from three junior radiology trainees and an additional senior radiologist. RESULTS It took our algorithm less than 30 s on average to process a 3D CT scan. For the two-type classification task (predicting bleeding or not), our algorithm achieved excellent values (≥ 0.98) across all reporting metrics on the subject level. For the five-type classification task (predicting five subtypes), our algorithm achieved > 0.8 AUC across all subtypes. The performance of our algorithm was generally superior to the average performance of the junior radiology trainees for both two-type and five-type classification tasks. CONCLUSIONS The proposed method was able to accurately detect ICH and its subtypes with fast speed, suggesting its potential for assisting radiologists and physicians in their clinical diagnosis workflow. KEY POINTS • A 3D joint CNN-RNN deep learning framework was developed for ICH detection and subtype classification, which has the flexibility to train with either subject-level labels or slice-level labels. • This deep learning framework is fast and accurate at detecting ICH and its subtypes. • The performance of the automated algorithm was superior to the average performance of three junior radiology trainees in this work, suggesting its potential to reduce initial misinterpretations.
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Affiliation(s)
- Hai Ye
- Department of Radiology, Shenzhen Second People's Hospital, Shenzhen Second Hospital Clinical Medicine College of Anhui Medical University, Shenzhen, China
| | - Feng Gao
- Department of Engineering, CuraCloud Corporation, Seattle, WA, USA
| | - Youbing Yin
- Department of Engineering, CuraCloud Corporation, Seattle, WA, USA
| | - Danfeng Guo
- Department of Engineering, CuraCloud Corporation, Seattle, WA, USA
| | - Pengfei Zhao
- Department of Engineering, CuraCloud Corporation, Seattle, WA, USA
| | - Yi Lu
- Department of Engineering, CuraCloud Corporation, Seattle, WA, USA
| | - Xin Wang
- Department of Engineering, CuraCloud Corporation, Seattle, WA, USA
| | - Junjie Bai
- Department of Engineering, CuraCloud Corporation, Seattle, WA, USA
| | - Kunlin Cao
- Department of Engineering, CuraCloud Corporation, Seattle, WA, USA
| | - Qi Song
- Department of Engineering, CuraCloud Corporation, Seattle, WA, USA
| | - Heye Zhang
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wei Chen
- Department of Radiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Radiology, Pingshan District People's Hospital, Shenzhen, Guangdong, China
| | - Xuejun Guo
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
| | - Jun Xia
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China.
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Rosyidi RM, Priyanto B, Al Fauzi A, Sutiono AB. Toward zero mortality in acute epidural hematoma: A review in 268 cases problems and challenges in the developing country. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2019. [DOI: 10.1016/j.inat.2019.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Guo C, Liu L, Wang B, Wang Z. Swirl sign in traumatic acute epidural hematoma: prognostic value and surgical management. Neurol Sci 2017; 38:2111-2116. [DOI: 10.1007/s10072-017-3121-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/07/2017] [Indexed: 11/24/2022]
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Zhang S, Wang S, Wan X, Liu S, Shu K, Lei T. Clinical evaluation of post-operative cerebral infarction in traumatic epidural haematoma. Brain Inj 2017; 31:215-220. [PMID: 28055227 DOI: 10.1080/02699052.2016.1227088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with traumatic epidural haematoma, undergoing the prompt and correct treatment, usually have favourable outcomes. However, secondary cerebral infarction may be life-threatening condition, as it is difficult to be identified before neurological impairment occurs. OBJECTIVE To evaluate the clinical data of patients with traumatic EDH and assess potential risk factors for post-operative cerebral infarction. METHODS The clinical data of patients with traumatic EDH were collected and analysed retrospectively. RESULTS The univariate analysis revealed 10 potential risk factors (the haematoma location, volume, the largest thickness and mid-line shift, basal cisterns compression, traumatic subarachnoid haemorrhage, pupil dilatation, pre-operative Glasgow Coma Scale score, ∆GCS and intraoperative brain pressure) for cerebral infarction with statistically significant difference. Of these factors, haematoma volume and basal cistern compression turned out to be the most significant risk factors through final multivariate logistic regression analysis. CONCLUSION The findings of this study can provide predictive factors for development of cerebral infarction and information for clinical decision-making and future studies.
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Affiliation(s)
- Suojun Zhang
- a Department of Neurosurgery , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , PR China
| | - Sheng Wang
- a Department of Neurosurgery , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , PR China
| | - Xueyan Wan
- a Department of Neurosurgery , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , PR China
| | - Shengwen Liu
- a Department of Neurosurgery , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , PR China
| | - Kai Shu
- a Department of Neurosurgery , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , PR China
| | - Ting Lei
- a Department of Neurosurgery , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , PR China
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Minimally Invasive Surgical Treatment of Acute Epidural Hematoma: Case Series. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6507350. [PMID: 27144170 PMCID: PMC4837251 DOI: 10.1155/2016/6507350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/09/2016] [Accepted: 03/17/2016] [Indexed: 11/29/2022]
Abstract
Background and Objective. Although minimally invasive surgical treatment of acute epidural hematoma attracts increasing attention, no generalized indications for the surgery have been adopted. This study aimed to evaluate the effects of minimally invasive surgery in acute epidural hematoma with various hematoma volumes. Methods. Minimally invasive puncture and aspiration surgery were performed in 59 cases of acute epidural hematoma with various hematoma volumes (13–145 mL); postoperative follow-up was 3 months. Clinical data, including surgical trauma, surgery time, complications, and outcome of hematoma drainage, recovery, and Barthel index scores, were assessed, as well as treatment outcome. Results. Surgical trauma was minimal and surgery time was short (10–20 minutes); no anesthesia accidents or surgical complications occurred. Two patients died. Drainage was completed within 7 days in the remaining 57 cases. Barthel index scores of ADL were ≤40 (n = 1), 41–60 (n = 1), and >60 (n = 55); scores of 100 were obtained in 48 cases, with no dysfunctions. Conclusion. Satisfactory results can be achieved with minimally invasive surgery in treating acute epidural hematoma with hematoma volumes ranging from 13 to 145 mL. For patients with hematoma volume >50 mL and even cerebral herniation, flexible application of minimally invasive surgery would help improve treatment efficacy.
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Kang J, Hong S, Hu C, Pyen J, Whang K, Cho S, Kim J, Kim S, Oh J. Clinical Analysis of Delayed Surgical Epidural Hematoma. Korean J Neurotrauma 2015; 11:112-7. [PMID: 27169075 PMCID: PMC4847500 DOI: 10.13004/kjnt.2015.11.2.112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 09/16/2015] [Accepted: 10/12/2015] [Indexed: 11/25/2022] Open
Abstract
Objective A small epidural hematoma (EDH) that has been diagnosed to be nonsurgical by initial brain computed tomography (CT) can increase in size and need surgical removal, resulting in a poor prognosis. However, there have been few studies, which focused delayed operated EDH. Therefore, we analyzed the clinical factors to determine the predicting factors of delayed operated EDH. Methods Between January 2011 and January 2014, 90 patients, who were admitted due to EDH, were enrolled in this study. None of the patients were indicated for operation initially. Based on the presence of surgery, we classified the patients into a delayed-surgery group (DG) and a non-surgical group (NG). Additionally, we analyzed them according to the following: time interval between the trauma and the initial CT, gender, age, medical history, drinking, change of mean arterial pressure (MAP), volume of EDH and other traumatic brain lesion. Results Among the 90 patients, the DG was 19 patients. Compared with NG, the DG revealed increased MAP, less presence of drinking, and a short time interval (DG vs. NG: +9.684 mm Hg vs. -0.428 mm Hg, 5.26% vs. 29.58%, 1.802 hours vs. 5.707 hours, respectively, p<0.05). Analyzing the time interval with receiver operating characteristic, there was 88.2% sensitivity and 68.3% specificity at the 2.05-hour cut-off value (area under the curve=0.854). Conclusion According to our results, the time interval between the trauma and the initial CT along with blood pressure change are potential predicting factors in the cases of delayed operation of EDH.
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Affiliation(s)
- Jiin Kang
- Department of Neurosurgery, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Soonki Hong
- Department of Neurosurgery, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Chul Hu
- Department of Neurosurgery, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Jinsoo Pyen
- Department of Neurosurgery, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kum Whang
- Department of Neurosurgery, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sungmin Cho
- Department of Neurosurgery, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Jongyeon Kim
- Department of Neurosurgery, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sohyun Kim
- Department of Neurosurgery, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Jiwoong Oh
- Department of Neurosurgery, Wonju College of Medicine, Yonsei University, Wonju, Korea
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Kornieieva M, Hadidy A, Zhuravlova I. Variability of the Middle Meningeal Artery Subject to the Shape of Skull. J Neurol Surg B Skull Base 2015; 76:451-8. [PMID: 26682123 DOI: 10.1055/s-0035-1554902] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/11/2015] [Indexed: 12/21/2022] Open
Abstract
Objectives Endovascular embolization of the middle meningeal artery (MMA) is currently considered one of the basic methods to treat acute bleeding and a posttraumatic aneurysm. The present research correlates the morphological characteristics of the MMA with individual skull shape. Design A prospective cohort study. Setting Hospital of University of Jordan (Amman, Jordan) from 2012 to 2013. Participants A total of 50 patients without known vascular pathology in the carotid system underwent routine magnetic resonance angiography examination of the head and neck. Main Outcome Measures The length and outer diameter of extracranial, intraosseous, and intracranial segments of the MMA were measured in patients with dolichocephalic, mesocephalic, and brachycephalic types of skulls. Results The brachycephalic patients have the most inauspicious anatomical precondition for endovascular intervention of the MMA due to the narrowest lumen of the vessel, high probability of a tortuous extracranial part, and pronounced inflexion at the transmission of the intraosseous segment to the intracranial one. Conclusions The morphological characteristics of the MMA have a close correlation with individual skull shape.
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Affiliation(s)
- Maryna Kornieieva
- Department of Anatomy, Tabuk University, Al Wajh, Tabuk, Saudi Arabia
| | - Azmy Hadidy
- Department of Diagnostic Radiology and Nuclear Medicine, Hospital of University of Jordan, University of Jordan, Amman, Jordan
| | - Iuliia Zhuravlova
- Department of Integrative Clinical Anatomy, Trinity School of Medicine, Kingstown, St. Vincent and the Grenadines
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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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Sellmann T, Miersch D, Kienbaum P, Flohé S, Schneppendahl J, Lefering R. The impact of arterial hypertension on polytrauma and traumatic brain injury. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:849-56. [PMID: 23267410 DOI: 10.3238/arztebl.2012.0849] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 10/02/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pre-hospital hypotension in trauma patients is associated with high mortality. Especially for patients with severe traumatic brain injury (TBI), arterial normotension or even hypertension (AHT) is considered an important mechanism for sustaining adequate cerebral perfusion pressure. The effect of pre-hospital arterial hypertension (pAHT) on in-hospital mortality after trauma has not been studied to date. METHODS We retrospectively analyzed data in the trauma registry of the German Society for Trauma Surgery (DGU) on all trauma patients in Germany from 1993 to 2008 who were 16 to 80 years old at the time of the trauma and had an injury severity score (ISS) of 9 or above (total, 42 500 patient data sets). For the analysis, we divided the patients into two groups: those with and those without TBI. We further divided the TBI patients into five subgroups depending on the course of their systolic blood pressure up to the moment of their arrival at the hospital. We also analyzed the patients' demographic data, patterns of injury, and accident mechanisms. RESULTS Trauma patients with TBI and pAHT (142 of 561 patients) had a significantly higher mortality than normotensive TBI patients (25.3% vs. 13.5%, p<0.001). Arterial hypertension that either rises or falls before the patient reaches the hospital is associated with higher in-hospital mortality. A logistical regression analysis of 5384 patients revealed that patients with pAHT (n = 561) had an odds ratio of 1.9 (95% confidence interval, 1.4 to 1.6) for death in the hospital compared to normotensive patients (n = 6020). CONCLUSION Systolic blood pressure values above 160 mm Hg before arrival in the hospital worsen the outcome of trauma patients with TBI.
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Affiliation(s)
- Timur Sellmann
- Department of Anaesthesiology and Intensive Care Medicine, Ev.Krankenhaus Bethesda zu Duisburg gGmbH
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