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KIYOHIRA M, SUEHIRO E, SHINOYAMA M, FUJIYAMA Y, HAJI K, SUZUKI M. Combined Strategy of Burr Hole Surgery and Elective Craniotomy under Intracranial Pressure Monitoring for Severe Acute Subdural Hematoma. Neurol Med Chir (Tokyo) 2021; 61:253-259. [PMID: 33597319 PMCID: PMC8048118 DOI: 10.2176/nmc.oa.2020-0266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/25/2020] [Indexed: 11/24/2022] Open
Abstract
Burr hole surgery in the emergency room can be lifesaving for patients with acute subdural hematoma (ASDH). In the first part of this study, a strategy of combined burr hole surgery, a period of intracranial pressure (ICP) monitoring, and then craniotomy was examined for safe and effective treatment of ASDH. Since 2012, 16 patients with severe ASDH with indications for burr hole surgery were admitted to Kenwakai Otemachi Hospital. From 2012 to 2016, craniotomy was performed immediately after burr hole surgery (emergency [EM] group, n = 10). From 2017, an ICP sensor was placed before burr hole surgery. After a period for correction of traumatic coagulopathy, craniotomy was performed when ICP increased (elective [EL] group, n = 6). Patient background, bleeding tendency, intraoperative blood transfusion, and outcomes were compared between the groups. In the second part of the study, ICP was measured before and after burr hole surgery in seven patients (including two of the six in the EL group) to assess the effect of this surgery. Activated partial thromboplastin time (APTT) and prothrombin time-international normalized ratio (PT-INR) were significantly prolonged after craniotomy in the EM group, but not in the EL group, and the EM group tended to require a higher intraoperative transfusion volume. The rate of good outcomes was significantly higher in the EL group, and ICP was significantly decreased after burr hole surgery. These results suggest the value of burr hole surgery followed by ICP monitoring in patients with severe ASDH. Craniotomy can be performed safely using this method, and this may contribute to improved outcomes.
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Affiliation(s)
- Miwa KIYOHIRA
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Eiichi SUEHIRO
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Chiba, Japan
| | - Mizuya SHINOYAMA
- Department of Neurosurgery, Kenwakai Otemachi Hospital, Kitakyushu, Fukuoka, Japan
| | - Yuichi FUJIYAMA
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
- Department of Neurosurgery, Shinyurigaoka General Hospital, Kawasaki, Kanagawa, Japan
| | - Kohei HAJI
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Michiyasu SUZUKI
- Department of Neurosurgery, Shinyurigaoka General Hospital, Kawasaki, Kanagawa, Japan
- Department of Advanced ThermoNeuroBiology, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
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Chen YC, Wang YF, Li JY, Chen SP, Lirng JF, Hseu SS, Tung H, Chen PL, Wang SJ, Fuh JL. Treatment and prognosis of subdural hematoma in patients with spontaneous intracranial hypotension. Cephalalgia 2015; 36:225-31. [DOI: 10.1177/0333102415585095] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/07/2015] [Indexed: 01/16/2023]
Abstract
Objective The objective of this article is to elucidate the outcome, prognostic predictors and timing of surgical intervention for subdural hematoma (SDH) in patients with spontaneous intracranial hypotension (SIH). Methods Patients with SDH were identified retrospectively from 227 consecutive SIH patients. Data were collected on demographics, clinical courses, neuroimaging findings, and treatment of SDH, which was later divided into conservative treatment, epidural blood patches (EBP), and surgical intervention. Poor outcome was defined as severe neurological sequelae or death. Results Forty-five patients (20%) with SDH (mean maximal thickness 11.9 ± 6.2 mm) were recruited. All 15 patients with SDH <10 mm achieved good outcomes by either conservative treatment or EBP. Of 30 patients with SDH ≥10 mm, patients with uncal herniation ( n = 3) had poor outcomes, even after emergent surgical evacuation ( n = 2), compared to those without ( n = 27) (100% vs. 0%, p < 0.001). Fourteen patients underwent surgical evacuation, resulting in good outcomes in all 12 who received early intervention and poor outcomes in the remaining two who received delayed intervention after Glasgow Coma Scale (GCS) score ≤8 (100% vs. 0%, p = 0.01). Conclusions Uncal herniation results in poor outcomes in patients with SIH complicated with SDH. In individuals with SDH ≥10 mm and decreased GCS scores, early surgical evacuation might prevent uncal herniation.
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Affiliation(s)
- Ying-Chu Chen
- Department of Neurology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan
| | - Yen-Feng Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taiwan
- Brain Research Center, National Yang-Ming University School of Medicine, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan
| | - Jie-Yuan Li
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan
- Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan
| | - Shih-Pin Chen
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan
- Brain Research Center, National Yang-Ming University School of Medicine, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan
| | - Jiing-Feng Lirng
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taiwan
| | - Shu-Shya Hseu
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan
- Department of Anesthesiology, Taipei Veterans General Hospital, Taiwan
| | - Hsin Tung
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan
- Division of Neurology, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan
| | - Po-Lin Chen
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan
- Division of Neurology, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan
| | - Shuu-Jiun Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan
- Brain Research Center, National Yang-Ming University School of Medicine, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan
| | - Jong-Ling Fuh
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taiwan
- Brain Research Center, National Yang-Ming University School of Medicine, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan
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