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Lee KB, Kim MH, Yoon JT, Song Y, Kwon B, Hwang SM, Choi JH, Lee DH. A simplified cranial cavity model to understand the relationship between intracranial pressure and dural sinus pressure. Interv Neuroradiol 2024; 30:57-63. [PMID: 35679068 PMCID: PMC10956465 DOI: 10.1177/15910199221107440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/27/2022] [Indexed: 11/15/2022] Open
Abstract
Although accurate intracranial pressure (ICP) monitoring is essential for the diagnosis and treatment of severe brain diseases, current methods are performed invasively. Therefore, a safe and less invasive ICP measurement is required. The purpose of our study was to develop a simplified cranial cavity model for a better understanding of the relationship between the ICP and the pressure measurement within the dural venous sinus (DVS) to support the validity of using sinus pressure as the surrogate of the ICP. The in-house cranial cavity model had three components: the brain part, the DVS part, and the subarachnoid space (SAS) part. Pressure in other parts was measured when the pressure in the SAS part and, separately, brain part was increased from 0 (baseline) to 50 mmHg at intervals of 10 mmHg. When the pressure in the SAS part was increased from 10 to 50 mmHg at 10 mmHg interval, pressures of both the brain and DVS parts increased without significant difference (all P > 0.05). However, pressures in both the SAS and DVS parts differed while the pressure in the brain part was increased. The pressures in both parts showed about 70% of the increase in the brain part. Nevertheless, the pressures in the SAS and DVS parts were not significantly different (P > 0.05). A simplified in-house cranial cavity model was developed consisting of three compartments to represent the actual intracranial spaces. The pressure measurement within the DVS was feasible to use as a surrogate for the ICP measurement.
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Affiliation(s)
- KB Lee
- Department of Radiologic Technology, Chungbuk Health & Science University, Cheongju 28150, Republic of Korea
| | - MH Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - J-T Yoon
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Y Song
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - B Kwon
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - SM Hwang
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - JH Choi
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - DH Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
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Tanaka T, Liu X, Momozaki N, Honda E, Suehiro E, Matsuno A. A Case of Two-stage Surgery Using Intracranial Pressure Monitoring for Hemorrhagic Infarction during Direct Oral Anticoagulant Medication. JMA J 2023; 6:561-564. [PMID: 37941700 PMCID: PMC10627977 DOI: 10.31662/jmaj.2023-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/26/2023] [Indexed: 11/10/2023] Open
Abstract
Direct oral anticoagulants (DOACs) are considered to cause a few hemorrhagic complications, including hemorrhagic infarction; these are administered in the acute phase of cerebral infarction for secondary prevention of cerebral embolism. Hemorrhagic infarction with cerebral herniation requires urgent decompressive craniectomy and can become fatal. Perioperative management is challenging because patients are often on antithrombotic therapy. In this study, we report on a case of a 61-year-old man with left-sided hemiparesis and impaired consciousness; he suffered from a hemorrhagic infarction with cerebral herniation during oral DOAC treatment after endovascular recanalization for the middle cerebral artery occlusion. As the patient was on apixaban for <3 h, performing decompressive craniectomy was considered difficult to stop hemostasis. We then opted to perform a small craniotomy to remove the hematoma, control the intracranial pressure (ICP), and administer fresh frozen plasma. We waited for the effect of apixaban to diminish before performing decompressive craniectomy. Gradually, his level of consciousness was noted to improve. Hemorrhagic cerebral infarction while on DOAC medications can be safely treated with small craniotomy and ICP monitoring followed by decompressive craniectomy. Thus, this case highlights the value of staged surgery under ICP monitoring in the absence of an immediate administration of DOAC antagonists.
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Affiliation(s)
- Tatsuya Tanaka
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Xuan Liu
- Department of Neurosurgery, Shiroishi Kyoritsu Hospital, Shiroishi, Japan
| | - Nobuaki Momozaki
- Department of Neurosurgery, Imari Arita Kyoritsu Hospital, Arita, Japan
| | - Eiichiro Honda
- Department of Neurosurgery, Shiroishi Kyoritsu Hospital, Shiroishi, Japan
| | - Eiichi Suehiro
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
| | - Akira Matsuno
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan
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Tanaka T, Goto H, Momozaki N, Honda E. Endoscopic hematoma evacuation for acute subdural hematoma with improvement of the visibility of the subdural space and postoperative management using an intracranial pressure sensor. Surg Neurol Int 2023; 14:1. [PMID: 36751441 PMCID: PMC9899456 DOI: 10.25259/sni_1084_2022] [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: 12/01/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023] Open
Abstract
Background The first choice to treat acute subdural hematoma (ASDH) is large craniotomy under general anesthesia. However, increasing age or the comorbid burden of patients may render invasive treatment strategy inappropriate. These medically frail patients with ASDH may benefit from a combination of small craniotomy and endoscopic hematoma removal, which is less invasive. We proposed covering with protective sheets to prevent brain injury due to contact with the endoscope and suction cannula and improve visualization of the subdural space. Moreover, we placed an intracranial pressure (ICP) sensor after endoscopic hematoma removal. In this article, we attempted to clarify the use of small craniotomy evacuation with endoscopy for ASDH. Methods Between January 2015 and December 2019, nine patients with ASDH underwent hematoma evacuation with endoscopy at our hospital. ASDH was removed using a suction tube with the aid of a rigid endoscope through the small craniotomy (5-6 cm). Improvement of the clinical symptoms and procedure-related complications was evaluated. Results No procedure-related hemorrhagic complications were observed. The outcomes of our endoscopic surgery were satisfactory without complications or rebleeding. The outcomes were not inferior to those of other reported endoscopic surgeries. Conclusion The results suggest that small craniotomy evacuation with endoscopy and postoperative management using an ICP sensor is a safe, effective, and minimally invasive treatment approach for ASDH in appropriately selected cases.
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Affiliation(s)
- Tatsuya Tanaka
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita,,Corresponding author: Tatsuya Tanaka, Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita, Japan.
| | - Hirofumi Goto
- Department of Neurology, International University of Health and Welfare, School of Medicine, Narita Hospital, Narita
| | - Nobuaki Momozaki
- Department of Neurosurgery, Imari Arita Kyoritsu Hospital, Arita, Japan
| | - Eiichiro Honda
- Department of Neurosurgery, Shiroishi Kyoritsu Hospital, Shiroishi, Japan
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Widdop L, Kaukas L, Wells A. Effect of Pre-Management Antithrombotic Agent Use on Outcome after Traumatic Acute Subdural Hematoma in the Elderly: A Systematic Review. J Neurotrauma 2023; 40:635-648. [PMID: 36266996 DOI: 10.1089/neu.2022.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Traumatic acute subdural hematomas (ASDH) are common in elderly patients (age ≥65 years) and are associated with a poorer prognosis compared with younger populations. Antithrombotic agent (ATA) use is also common in the elderly; however, the influence that pre-morbid ATA has on outcome in ASDH is poorly understood. We hypothesized that pre-morbid ATA use significantly worsens outcomes in elderly patients presenting with traumatic ASDH. English language medical literature was searched for articles relating to ATA use in the elderly with ASDH. Data were collated and appraised where possible. Analyses of study bias were performed. Twelve articles encompassing 2038 patients were included; controls were poorly described in the included studies. Pre-morbid ATA use was seen in 1042 (51.1%) patients and 18 different ATA combination therapies were identified, with coumarins being the most common single agent used. The newer direct oral anticoagulants were evaluated in only two studies. ATA use was associated with a lower presenting Glasgow Coma Scale (GCS) score but not hematoma volume on computed tomography (CT) or post-operative hematoma re-accumulation. No studies connected ATA use with patient outcomes without the presence of confounders and bias. Reversal strategies, bridging therapy, recommencement of ATA, and comparison groups were poorly described; accordingly, our hypothesis was rejected. ATA reversal methods, identification of surgical candidates, optimal surgery methods, and when or whether ATA should be recommenced following ASDH resolution remain topics of debate. This study defines our current understanding on this topic, revealing clear deficiencies in the literature with recommendations for future research.
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Affiliation(s)
- Liam Widdop
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lola Kaukas
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Adam Wells
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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NAKAE R, MURAI Y, TAKAYAMA Y, NAMATAME K, MATSUMOTO Y, KANAYA T, FUJIKI Y, ONDA H, SUZUKI G, KANEKO J, ARAKI T, NAOE Y, SATO H, UNEMOTO K, MORITA A, YOKOTA H, YOKOBORI S. Neurointensive Care of Traumatic Brain Injury Patients Based on Coagulation and Fibrinolytic Parameter Monitoring. Neurol Med Chir (Tokyo) 2022; 62:535-541. [PMID: 36223950 PMCID: PMC9831625 DOI: 10.2176/jns-nmc.2022-0226] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Coagulopathy, a common complication of traumatic brain injury (TBI), is characterized by a hypercoagulable state developing immediately after injury, with hyperfibrinolysis and bleeding tendency peaking 3 h after injury, followed by fibrinolysis shutdown. Reflecting this timeframe, the coagulation factor fibrinogen is first consumed and then degraded after TBI, its concentration rapidly decreasing by 3 h post-TBI. The fibrinolytic marker D-dimer reaches its maximum concentration at the same time. Hyperfibrinolysis in the acute phase of TBI is associated with poor prognosis via hematoma expansion. In the acute phase, the coagulation and fibrinolysis parameters must be monitored to determine the treatment strategy. The combination of D-dimer plasma level at admission and the level of consciousness upon arrival at the hospital can be used to predict the patients who will "talk and deteriorate." Fibrinogen and D-dimer levels should determine case selection and the amount of fresh frozen plasma required for transfusion. Surgery around 3 h after injury, when fibrinolysis and bleeding diathesis peak, should be avoided if possible. In recent years, attempts have been made to estimate the time of injury from the time course of coagulation and fibrinolysis parameter levels, which has been particularly useful in some cases of pediatric abusive head trauma patients.
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Affiliation(s)
- Ryuta NAKAE
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Yasuo MURAI
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Yasuhiro TAKAYAMA
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Kaoru NAMATAME
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshiyuki MATSUMOTO
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Takahiro KANAYA
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Yu FUJIKI
- Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
| | - Hidetaka ONDA
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Go SUZUKI
- Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
| | - Junya KANEKO
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Takashi ARAKI
- Department of Traumatology, Saitama Children's Medical Center, Saitama, Saitama, Japan
| | - Yasutaka NAOE
- Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, Kawaguchi, Saitama, Japan
| | - Hidetaka SATO
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Kyoko UNEMOTO
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Akio MORITA
- Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Hiroyuki YOKOTA
- Graduate School of Medical and Health Science, Nippon Sport Science University, Yokohama, Kanagawa, Japan
| | - Shoji YOKOBORI
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
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Li J, Zhang X, Su H, Qu Y, Piao M. Investigation of the Effects of Large Bone Flap Craniotomy on Cerebral Hemodynamics, Intracranial Infection Rate, and Nerve Function in Patients with Severe Craniocerebral Trauma. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:2681278. [PMID: 36101799 PMCID: PMC9462990 DOI: 10.1155/2022/2681278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/11/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022]
Abstract
In order to explore the clinical value of large bone flap craniotomy, the effects of standard large bone flap craniotomy on cerebral hemodynamic indexes, incidence of postoperative intracranial infection, and neurological function in patients with severe craniocerebral trauma are investigated. 89 patients with severe craniocerebral trauma admitted from January 2020 to June 2021 are analyzed retrospectively. All patients are divided into a large craniotomy group (n = 45) and control group (n = 44) according to different surgical methods. The large craniotomy group is treated with large craniotomy decompression, and the control group is treated with traditional craniotomy decompression. The incidence of intracranial infection in each group is recorded, and NIHSS is applied to observe the neurological function recovery of 2 groups before and 1 month after operation. Besides, the patients are followed up after surgery and the Kaplan-Meier survival curve is obtained to compare the survival rate of patients in the two groups. It is clearly evident that the two surgical methods have certain clinical efficacy in the treatment of patients with severe craniocerebral trauma. Comparatively, the large craniotomy can further improve brain blood supply and improve neurological function recovery. Also, it can obtain low incidence of postoperative adverse reactions and intracranial infection.
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Affiliation(s)
- JiNan Li
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - XinLi Zhang
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Hang Su
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - YaNan Qu
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
| | - Meixuan Piao
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China
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