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Chen L, Yue Y, Luo P, Qu Y, Fang J, Xin C, Lv L, Luan J, Cheng Z, Yang Z, Sun Y. Clinical analysis of hyperbaric oxygen combined with subdural drilling and drainage in the management of subdural effusion type IV with intracranial infection in infant patients. Front Neurol 2024; 15:1340650. [PMID: 38469593 PMCID: PMC10925761 DOI: 10.3389/fneur.2024.1340650] [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: 11/18/2023] [Accepted: 02/12/2024] [Indexed: 03/13/2024] Open
Abstract
Background To explore the therapeutic effect of hyperbaric oxygen combined with subdural drilling and drainage (SDD) on subdural effusion type IV with intracranial infection in infant patients. Methods This retrospective controlled study included 328 infant patients with subdural effusion type 4 with intracranial infection between January 2005 and January 2023. 178 patients were treated by hyperbaric oxygen combined with SDD (group A). 142 cases were treated with SDD (group B). 97 infants were only received hyperbaric oxygen (group C). Clinical outcomes, the control time of intracranial infection, complications, and the degree of brain re-expansion after 6 months of treatment were compared among the three groups. According to the comprehensive evaluation of treatment effectiveness and imaging results, it is divided into four levels: cured, significantly effective, improved, and ineffective. Results No patient died during follow-up. The three groups were similar regarding age, sex, the general information, and clinical symptoms (p > 0.05). All intracranial infections in the children were effectively controlled. There was no difference in infection control time between group A and group B, and there was no statistical significance. However, the control time of intracranial infection between the two groups was different from that of group C, which was statistically significant. Compared with group B and group C, the degree of brain re-expansion in group A has obvious advantages and significant differences. The effective rates of the three groups were 83.7%, 58.5%, and 56.7%, respectively. There were 28 cases of subcutaneous hydrops in group A and 22 cases of subcutaneous hydrops in group B after operation, and no other serious complications. Conclusion The SDD is safe and effective for infant patients with intracranial infections through fluid replacement and intrathecal antibacterial. Hyperbaric oxygen is effective as an adjuvant therapy to promote brain re-expansion.
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Affiliation(s)
- Liuyin Chen
- Department of Neurosurgery, Hebei Provincial Children's Hospital, Shijiazhuang, Hebei, China
| | - Yanke Yue
- Department of Neurosurgery, Hebei Provincial Children's Hospital, Shijiazhuang, Hebei, China
| | - Pengyuan Luo
- Department of Neurosurgery, Hebei Provincial Children's Hospital, Shijiazhuang, Hebei, China
| | - Yi Qu
- Department of Neurosurgery, Hebei Provincial Children's Hospital, Shijiazhuang, Hebei, China
| | - Jiangshun Fang
- Department of Neurosurgery, Hebei Provincial Children's Hospital, Shijiazhuang, Hebei, China
| | - Chaojun Xin
- Department of Neurosurgery, Hebei Provincial Children's Hospital, Shijiazhuang, Hebei, China
| | - Lige Lv
- Department of Neurosurgery, Hebei Provincial Children's Hospital, Shijiazhuang, Hebei, China
| | - Jimei Luan
- Department of Neurosurgery, Hebei Provincial Children's Hospital, Shijiazhuang, Hebei, China
| | - Zhenghai Cheng
- Department of Neurosurgery, Hebei Provincial Children's Hospital, Shijiazhuang, Hebei, China
| | - Zhiguo Yang
- Department of Neurosurgery, Hebei Provincial Children's Hospital, Shijiazhuang, Hebei, China
| | - Yaning Sun
- Department of Neurosurgery, Hebei Provincial Children's Hospital, Shijiazhuang, Hebei, China
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Abdala-Vargas NJ, Umana GE, Patiño-Gomez JG, Ordoñez-Rubiano E, Cifuentes-Lobelo HA, Palmisciano P, Ferini G, Viola A, Zagardo V, Casanova-Martínez D, Tomasi OS, Campero A, Baldoncini M. Standardization of Strategies to Perform a Parafascicular Tubular Approach for the Resection of Brain Tumors in Eloquent Areas. Brain Sci 2023; 13:brainsci13030498. [PMID: 36979308 PMCID: PMC10046766 DOI: 10.3390/brainsci13030498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Objective: The aim of this work is to define a methodological strategy for the minimally invasive tubular retractor (MITR) parafascicular transulcal approach (PTA) for the management of brain tumors sited in eloquent areas. Methods: An observational prospective study was designed to evaluate the benefits of PTA associated with MITRs, tractography and intraoperative cortical stimulation. They study was conducted from June 2018 to June 2021. Information regarding white matter tracts was processed, preventing a potential damage during the approach and/or resection. All patients older than 18 years who had a single brain tumor lesion were included in the study. Patients with a preoperative Karnofsky Performance Scale (KPS) score greater than 70% and a Glasgow Coma Scale (GCS) score > 14 points were included. Results: 72 patients were included in the study, the mean age was 49.6, the most affected gender was male, 12.5% presented aphasia, 11.1% presented paraphasia, 41.6% had motor deficit, 9.7% had an affection in the optic pathway, the most frequently affected region was the frontal lobe (26.3%), the most frequent lesions were high-grade gliomas (34.7%) and the measurement of the incisions was on average 5.58 cm. Of the patients, 94.4% underwent a total macroscopic resection and 90.2% did not present new postoperative neurological deficits. In all cases, a PTA was used. Conclusion: Tubular minimally invasive approaches (MIAs) allow one to perform maximal safe resection of brain tumors in eloquent areas, through small surgical corridors. Future comparative studies between traditional and minimally invasive techniques are required to further investigate the potential of these surgical nuances.
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Affiliation(s)
- Nadin J. Abdala-Vargas
- Neurosurgery Department, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital Infantil Universitario de San José, Cra. 19 #8A-32, Bogotá 111221, Colombia
| | - Giuseppe E. Umana
- Department of Neurosurgery, Trauma and Gamma-Knife Center Cannizzaro Hospital, 95126 Catania, Italy
- Correspondence:
| | - Javier G. Patiño-Gomez
- Neurosurgery Department, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital Infantil Universitario de San José, Cra. 19 #8A-32, Bogotá 111221, Colombia
| | - Edgar Ordoñez-Rubiano
- Neurosurgery Department, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital Infantil Universitario de San José, Cra. 19 #8A-32, Bogotá 111221, Colombia
| | - Hernando A. Cifuentes-Lobelo
- Neurosurgery Department, Fundación Universitaria de Ciencias de la Salud (FUCS), Hospital Infantil Universitario de San José, Cra. 19 #8A-32, Bogotá 111221, Colombia
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia s.r.l., 95029 Vaigrande, Italy
| | - Anna Viola
- Department of Radiation Oncology, REM Radioterapia s.r.l., 95029 Vaigrande, Italy
| | - Valentina Zagardo
- Department of Radiation Oncology, REM Radioterapia s.r.l., 95029 Vaigrande, Italy
| | | | - Ottavio S. Tomasi
- Department of Neurosurgery, Christian-Doppler-Klinik, Paracelsus Private Medical University, 5020 Salzburg, Austria
| | - Alvaro Campero
- Department of Neurological Surgery, Padilla Hospital, Tucumán T4000, Argentina
| | - Matias Baldoncini
- Department of Neurological Surgery, San Fernando Hospital, Buenos Aires B1646, Argentina
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Sağıroğlu S, Turgut M. Subdural Hematomas in Adults and Children. Adv Tech Stand Neurosurg 2023; 46:193-203. [PMID: 37318576 DOI: 10.1007/978-3-031-28202-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Subdural hematoma is a common entity encountered by the neurosurgeon. The disease has acute, subacute, and chronic forms. Management of the disease changes according to the etiology of the lesion, yet the main goals are, as with most neurosurgical interventions, decompression of neural tissue and restoration of perfusion. Due to various forms and causes of the disease such as trauma, anticoagulant/antiaggregant use, arterial rupture, oncologic hemorrhages, intracranial hypotension, and idiopathic hemorrhages, several approaches for management have been documented in the literature. Herewith, we present various up-to-date management options for the disease.
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Affiliation(s)
- Sinan Sağıroğlu
- Department of Neurosurgery, Aydın Adnan Menderes University School of Medicine, Efeler, Aydın, Turkey
| | - Mehmet Turgut
- Department of Neurosurgery, Aydın Adnan Menderes University School of Medicine, Efeler, Aydın, Turkey
- Department of Histology and Embryology, Aydın Adnan Menderes University Health Sciences Institute, Efeler, Aydın, Turkey
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Nguyen VN, Wallace D, Ajmera S, Akinduro O, Smith LJ, Giles K, Vaughn B, Klimo P. Management of Subdural Hematohygromas in Abusive Head Trauma. Neurosurgery 2020; 86:281-287. [PMID: 31321424 DOI: 10.1093/neuros/nyz076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 02/16/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The optimal management of nonacute subdural fluid collections in infantile abusive head trauma (AHT) remains controversial. OBJECTIVE To review the outcomes and costs of the various treatments for symptomatic subdural fluid collections in children with AHT at a single center. METHODS Our AHT database was queried to identify children requiring any intervention for hematohygromas. Demographic, hospital course, radiologic, cost, readmission, and follow-up information were collected. RESULTS From January 2009 to March 2018, the authors identified 318 children with AHT, of whom 210 (66%) had a subdural collection of any type (blood or cerebrospinal fluid). A total of 50 required some form of intervention specifically for chronic hematohygromas. The initial management consisted of transfontanelle percutaneous aspiration (n = 31), burr holes with (n = 12) or without (n = 3) external subdural drainage, and mini-craniotomy (n = 4). Of those who were initially managed with 1 or more needle aspiration, 23 (74%) required further intervention-12 subduroperitoneal shunts and 11 nonshunt procedures. No patient who underwent burr holes/external drainage required further intervention (n = 16). Overall, the average number of interventions needed in these 50 children for definitive treatment was 1.8 (range, 1-4). A total of 15 children ultimately required a subduroperitoneal shunt. Complications (infectious, hemorrhagic, and thrombotic) were significant and occurred in all treatment groups except burr holes without drainage (n = 3). The average hospital charge for the entire cohort was $166 300.25 (range, $19 126-$739 248). CONCLUSION Based on our experience to date, burr hole with controlled external subdural drainage is an effective and preferred treatment for traumatic hematohygromas; complications and need for additional intervention is low.
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Affiliation(s)
- Vincent N Nguyen
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - David Wallace
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sonia Ajmera
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Oluwatomi Akinduro
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Lydia J Smith
- Neuroscience Institute, LeBonheur Children's Hospital, Memphis, Tennessee
| | - Kim Giles
- Neuroscience Institute, LeBonheur Children's Hospital, Memphis, Tennessee
| | - Brandy Vaughn
- Neuroscience Institute, LeBonheur Children's Hospital, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Neuroscience Institute, LeBonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
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Palmer AW, Albert GW. Minicraniotomy with a subgaleal pocket for the treatment of subdural fluid collections in infants. J Neurosurg Pediatr 2019; 23:480-485. [PMID: 30717055 DOI: 10.3171/2018.11.peds18322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 11/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Various surgical techniques have been described to treat subdural fluid collections in infants, including transfontanelle aspiration, burr holes, subdural drain, subduroperitoneal shunt, and minicraniotomy. The purpose of this study was to describe a modification of the minicraniotomy technique that avoids the implantation of external drainage catheters and potentially carries a higher success rate. METHODS In this retrospective study, the authors describe 11 cases involving pediatric patients who underwent parietal minicraniotomies for the evacuation of subdural fluid collections. In contrast to cases previously described in the literature, no patient received a drain; instead, a subgaleal pocket was created such that the fluid could flow from the subdural to the subgaleal space. Preoperative and postoperative data were reviewed, including neurological examination findings, radiological findings, complications, hospital length of stay, and findings on follow-up examinations and imaging. The primary outcome was failure of the treatment strategy, defined as an increase in subdural fluid collection requiring further intervention. RESULTS Eleven patients (8 boys and 3 girls, median age 4.5 months) underwent the described procedure. Eight of the patients had complete resolution of the subdural collection on follow-up imaging, and 2 had improvement. One patient had a new subdural collection due to a second injury. Only 1 patient underwent aspiration and subsequent surgical repair of a pseudomeningocele after the initial surgery. Notably, no patients required subduroperitoneal shunt placement. CONCLUSIONS The authors describe a new surgical option for subdural fluid collections in infants that allows for more aggressive evacuation of the subdural fluid and eliminates the need for a drain or shunt placement. Further work with more patients and direct comparison to other alternative therapies is necessary to fully evaluate the efficacy and safety of this new technique.
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Affiliation(s)
- Angela W Palmer
- 1Department of Neurosurgery, University of Arkansas for Medical Sciences; and
- 2Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Gregory W Albert
- 1Department of Neurosurgery, University of Arkansas for Medical Sciences; and
- 2Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas
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Wang X, Zhang X, Cao H, Jing S, Yang Z, Cheng Z, Liu Y, Li X, Gao F, Ji Y. Surgical Treatments for Infantile Purulent Meningitis Complicated by Subdural Effusion. Med Sci Monit 2015; 21:3166-71. [PMID: 26482715 PMCID: PMC4621163 DOI: 10.12659/msm.895747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Infantile purulent meningitis (PM) is a commonly severe intracranial infectious disease in infants under age 1 year. In recent years, several diagnostic and treatment methods were reported, but in these cases the neurological complications and sequel were often observed, among which subdural effusion (SE) is the most common complication in PM. Timely diagnosis and early intervention are vital for better outcomes. In this study, the surgical treatments for infantile PM complicated by SE were investigated. Material/Methods Patients who had PM complicated by SE in the Children’s Hospital of Hebei Province from June 2000 to June 2012 were retrospectively analyzed and 170 patients were enrolled in the study. Surgical treatment for each patient was adopted according to producing effusion time, leucocyte count, protein content, intracranial pressure, and bacteria culture, coupled with cranial ultrasound examination, CT, and MRI scans. Results Nearly, 15 patients were cured using serial taps, with a 50% cure rate. Seventeen out of 30 (56.6%) patients receiving subcutaneous reservoir drainage had better outcome. Nearly 80% of patients (55/69) who underwent minimally invasive trepanation and drainage were positive. Surgical procedure of minimally invasive trepanation and drainage combined with drug douche was effective in 63% of patients (19/30). In addition, 6 patients were cured with subdural-peritoneal shunt. Only 1 patient died, after the recurrence of meningitis, and the remaining 4 patients were cured by craniotomy. Conclusions For infantile PM complicated with SE, treatment needs be chosen according to the specific situation. Surgical procedure of minimally invasive trepanation and drainage is a very effective treatment in curing PM complicated by SE. The treatment was highly effective with the use of drug douche. Subdural-peritoneal shunt and craniotomy were as effective as in refractory cases.
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Affiliation(s)
- Xianshu Wang
- Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland)
| | - Xiaoru Zhang
- Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland)
| | - Hongbin Cao
- Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland)
| | - Shiyuan Jing
- Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland)
| | - Zhiguo Yang
- Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland)
| | - Zhenghai Cheng
- Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland)
| | - Ye Liu
- Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland)
| | - Xin Li
- Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland)
| | - Feifei Gao
- Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland)
| | - Yuanqi Ji
- Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland)
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Blauwblomme T, Di Rocco F, Bourgeois M, Beccaria K, Paternoster G, Verchere-Montmayeur J, Sainte-Rose C, Zerah M, Puget S. Subdural to subgaleal shunts: alternative treatment in infants with nonaccidental traumatic brain injury? J Neurosurg Pediatr 2015; 15:306-9. [PMID: 25555119 DOI: 10.3171/2014.9.peds1485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The ideal treatment for subdural hematomas (SDHs) in infants remains debated. The aim of this study was to analyze the safety and efficiency of subduro-subgaleal drainage in SDH. METHODS The authors conducted a single-center open-label study between August 2011 and May 2012. Data were prospectively collected in a database and retrospectively analyzed. RESULTS Eighteen patients (male/female ratio 1.25) with a median age of 5 months were surgically treated. All had preoperative symptoms of intracranial hypertension or seizures. The SDH was bilateral in 16 cases, with a median width of 12 mm. Success of the procedure was noted in 14 of the 18 patients. There was no intraoperative complication or postoperative infection. Drainage failure was attributable to suboptimal positioning of the subdural drain in 2 cases and to migration in 1 case. CONCLUSIONS Subduro-subgaleal drainage is an efficient treatment that could be proposed as an alternative to external subdural drainage or subduroperitoneal drainage.
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Regan JM, Worley E, Shelburne C, Pullarkat R, Watson JC. Burr hole washout versus craniotomy for chronic subdural hematoma: patient outcome and cost analysis. PLoS One 2015; 10:e0115085. [PMID: 25611468 PMCID: PMC4303411 DOI: 10.1371/journal.pone.0115085] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 11/18/2014] [Indexed: 11/25/2022] Open
Abstract
Chronic subdural hematomas (CSDH), which are frequently encountered in neurosurgical practice, are, in the majority of cases, ideally treated with surgical drainage. Despite this common practice, there is still controversy surrounding the best surgical procedure. With lack of clear evidence of a superior technique, surgeons are free to base the decision on other factors that are not related to patient care. A retrospective chart review of 119 patients requiring surgical drainage of CSDH was conducted at a large tertiary care center over a three-year period. Of the cases reviewed, 58 patients underwent craniotomy, while 61 patients underwent burr hole washout. The study focused on re-operation rates, mortality, and morbidity, as measured by Glasgow coma scores (GCS), discharge Rankin disability scores, and discharge disposition. Secondary endpoints included length of stay and cost of procedure. Burr hole washout was superior to craniotomy with respect to patient outcome, length of stay and recurrence rates. In both study groups, patients required additional surgical procedures (6.6% of burr hole patients and 24.1% of craniotomy patients) (P = 0.0156). Of the patients treated with craniotomy, 51.7% were discharged home, whereas 65.6% of the burr hole patients were discharged home. Patients who underwent burr hole washout spent a mean of 78.8 minutes in the operating suite while the patients undergoing craniotomy spent 129.4 minutes (P < 0.001). The difference in mean cost per patient, based solely on operating time, was $2,828 (P < 0.001). This does not include the further cost due to additional procedures and hospital stay. The mean length of stay after surgical intervention was 3 days longer for the craniotomy group (P = 0.0465). Based on this retrospective study, burr hole washout is superior for both patients’ clinical and financial outcome; however, prospective long-term multicenter clinical studies are required to verify these findings.
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Affiliation(s)
| | - Emmagene Worley
- Virginia Commonwealth University, Inova Campus, Falls Church, VA, United States of America
| | - Christopher Shelburne
- Inova Fairfax Hospital, Department of Neurosciences, Falls Church, VA, United States of America
| | - Ranjit Pullarkat
- Virginia Commonwealth University, Inova Campus, Falls Church, VA, United States of America
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Van Der Veken J, Duerinck J, Buyl R, Van Rompaey K, Herregodts P, D’Haens J. Mini-craniotomy as the primary surgical intervention for the treatment of chronic subdural hematoma--a retrospective analysis. Acta Neurochir (Wien) 2014; 156:981-7. [PMID: 24615068 DOI: 10.1007/s00701-014-2042-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The incidence of chronic subdural hematoma (CSDH) is increasing, but optimal treatment remains controversial. Recent meta-analyses suggest burr hole (BH) drainage is the best treatment because it provides optimal balance between recurrence and morbidity. Mini-craniotomy may offer supplementary technical advantages while maintaining equal or better outcomes. This study investigates the outcome of mini-craniotomy as the sole treatment in patients with CSDH. METHOD We analyzed all patients operated on for CSDH with mini-craniotomy in our neurosurgical center between 2005-2010. Baseline patient characteristics (age, sex, comorbidities, imaging characteristics, known risk factors for development of CSDH and neurological examination at presentation) and outcomes (mortality, complications, recurrence and neurological examination at discharge) were recorded. RESULTS One hundred twenty-six adult patients were included, mean age was 73.9 (range 18 to 95) years old, and the sex ratio (M:F) was 2:1. Eighty-four percent of the patients showed clinical improvement at discharge, as shown by a decrease in the Markwalder score postoperatively (with 57 % Markwalder 0 and 23 % Markwalder 1). Recurrence rate was 8.7 %. Overall complication rate was 34.1 % (27.8 % medical complications and 6.3 % surgical complications). In-hospital mortality was 13.5 % (8.7 % due to pulmonary infections and 1.6 % to surgical complications). Preoperative Markwalder grade correlated significantly with complication rate, as did the presence of a neurodegenerative disease (p = 0.018). Factors significantly related to mortality in univariate analysis were arterial hypertension (p = 0.038), heart failure (p = 0.02), renal failure (p = 0.017), neurodegenerative disease (p = 0.001), cerebrovascular accident (p = 0.008) and coagulopathy (p = 0.019). Multivariate analysis was not able to confirm any significant relationship. CONCLUSION This is the first published series of CSDH in which all consecutive patients were operated on by mini-craniotomy. The invasiveness and complication rate of mini-craniotomy are equal to those of burr hole treatment, but visualization is superior, resulting in lower recurrences. A randomized controlled trial is indicated to identify the best surgical strategy for the treatment of CSDH.
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Satyarthee GD, Pankaj D, Sharma BS. "Rabbit Ear" scalp deformity caused by massive subdural effusion in infant following bilateral burr-hole drainage. J Pediatr Neurosci 2014; 8:235-8. [PMID: 24470822 PMCID: PMC3888045 DOI: 10.4103/1817-1745.123690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Subdural effusion (SDE) in an infant is a rare clinical scenario, which may be secondary to a variety of etiologies. Massive SDE is an extremely rare complication of head injury. It usually runs a self-limiting course. Though neurosurgical intervention is occasionally needed, different methods of surgical procedure for management includes burr-hole alone, burr-holes with subdural drain placement, twist drill craniotomy with drain and even craniotomy. The authors report a rare case of progressive massive SDE, which despite bilateral burr-hole placement and drainage failed and presented with visual deterioration and massive bulge of scalp at burr-hole sites producing rabbit ear sign in a 10 month old infant. Ultimately cystoperitoneal shunt was carried out in a desperate attempt to prevent impending rupture of scalp sutures at sites of previous burr-hole placement. Astonishingly not only complete resolution of hygroma, but visual recovery also took place. Patient is doing well at 6 months following shunt with regaining normal vision and appropriate developmental milestones. A magnetic resonance imaging scan of brain at last follow-up revealed mild ventriculomegaly with subduro-peritoneal shunt in situ and rest of brain was unremarkable. Such cases have not been reported in literature until date.
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Affiliation(s)
- Guru Dutta Satyarthee
- Department of Neurosurgery, All India Institute of Medical Sciences and Associated Jai Prakash Narayan Apex Trauma Centre, New Delhi, India
| | - Dawar Pankaj
- Department of Neurosurgery, All India Institute of Medical Sciences and Associated Jai Prakash Narayan Apex Trauma Centre, New Delhi, India
| | - B S Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences and Associated Jai Prakash Narayan Apex Trauma Centre, New Delhi, India
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"Rabbit ear" scalp deformity caused by massive subdural effusion in infant following bilateral bur-hole drainage failure: successfully managed with subduro-peritoneal shunt. Childs Nerv Syst 2013; 29:1993-6. [PMID: 23881426 DOI: 10.1007/s00381-013-2233-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Subdural effusion in an infant is a rare clinical scenario which may be secondary to a variety of etiologies. Massive subdural effusion is an extremely rare complication of head injury. CASE REPORT Authors report a rare case of progressive massive subdural effusion which, despite bilateral bur-hole placement and drainage, failed and presented with visual deterioration and massive bulge of the scalp at bur-hole sites, producing a rabbit ear appearance in a 10-month-old infant. Ultimately, cystoperitoneal shunt was carried out in a desperate attempt to prevent impending rupture of scalp sutures at sites of previous bur-hole placement. This was followed by not only complete resolution of hygroma but also visual recovery. The patient is doing well at 6 months following shunt, regaining normal vision and appropriate developmental milestones. A MRI scan of the brain was carried out at last follow-up, which revealed mild ventriculomegaly with the rest of the brain being unremarkable, and subduro-peritoneal shunt in situ. Such a case has not been reported in the literature till date. DISCUSSION Subdural effusion usually runs a self-limiting course. Though neurosurgical intervention is occasionally needed, different methods of surgical procedure for management include bur hole alone, bur holes with subdural drain placement, twist drill craniotomy with drain, and even craniotomy. Various methods of management are discussed along with a review of pertinent literature.
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12
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Sharma P, Mishra A, Arora G, Tripathi M, Bal C, Kumar R. Post meningitis subdural hygroma: Anatomical and functional evaluation with (99m)Tc-ehylene cysteine dimer single photon emission tomography/computed tomography. Indian J Nucl Med 2013; 28:23-5. [PMID: 24019670 PMCID: PMC3764686 DOI: 10.4103/0972-3919.116806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Subdural hygroma is the collection of cerebrospinal fluid in the subdural space. Most often these resolve spontaneously. However, in cases with neurological complications surgical drainage may be needed. We here, present the case of an 8-year-old boy with post meningitis subdural hygroma. (99m)Tc-ehylene cysteine dimer ((99m)Tc-ECD) hybrid single photon emission tomography/computed tomography (SPECT/CT) carried out in this patient, demonstrated the subdural hygroma as well as the associated cerebral hypoperfusion. If (99m)Tc-ECD SPECT/CT is integrated into management of these patients, it can help in decision making with respect to conservative versus surgical management.
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Affiliation(s)
- Punit Sharma
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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The case for mini-craniotomy in the management of chronic subdural hematoma. Acta Neurochir (Wien) 2013; 155:189-90. [PMID: 23108560 DOI: 10.1007/s00701-012-1539-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
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