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Song F, Zhou Z, Zhou X, Wu H, Shan B, Zhou Z, Dai J, Jiang F. Initial experience of 3-dimensional exoscope in decompression of massive lumbar disc herniation. BMC Surg 2024; 24:34. [PMID: 38267970 PMCID: PMC10809480 DOI: 10.1186/s12893-024-02321-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVES To investigate the effect of a three-dimensional (3D) exoscope for decompression of single-segment massive lumbar disc herniation (LDH). METHODS The study included 56 consecutive patients with single segment massive LDH who underwent decompression assisted by a 3D exoscope from October 2019 to October 2022 at a university hospital. The analysis was based on comparison of perioperative metrics including decompression time, estimated blood loss (EBL) during decompression and postoperative length of stay (PLS); clinical outcomes including assessment using the visual analogue scale (VAS) and the Oswestry disability index (ODI); and incidence of reoperation and complications. RESULTS The mean decompression time was 28.35 ± 8.93 min (lumbar interbody fusion (LIF)) and 15.50 ± 5.84 min (fenestration discectomy (LOVE surgery)), the mean EBL during decompression was 42.65 ± 12.42 ml (LIF) and 24.32 ± 8.61 ml (LOVE surgery), and the mean PLS was 4.56 ± 0.82 days (LIF) and 2.00 ± 0.65 days (LOVE surgery). There were no complications such as cerebrospinal fluid leakage, nerve root injury and epidural hematoma. All patients who underwent decompression assisted by a 3D exoscope were followed up for 6 months. At the last follow-up, the VAS and ODI scores were significantly improved from the preoperative period to the last follow-up (P < 0.05). CONCLUSIONS A 3D exoscope provides a visually detailed, deep and clear surgical field, which makes decompression safer and more effective and reduces short-term complications. A 3D exoscope may be a good assistance tool during decompression for single-segment massive LDH.
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Affiliation(s)
- Fanglong Song
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Zhiqiang Zhou
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Xiaozhong Zhou
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Haowei Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Bingchen Shan
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Zhentao Zhou
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China
| | - Jun Dai
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China.
| | - Fengxian Jiang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China.
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Lou X, Chen P, Shen J, Chen J, Ge Y, Ji W. Why does such a cyst appear after unilateral biportal endoscopy surgery: A case report and literature review. Medicine (Baltimore) 2023; 102:e36665. [PMID: 38115266 PMCID: PMC10727571 DOI: 10.1097/md.0000000000036665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Unilateral biportal endoscopy (UBE) has been widely and skillfully used in the treatment of lumbar disc herniation and spinal canal stenosis. UBE surgery also brings some complications, such as dural tear, epidural hematoma, residual nucleus pulposus, etc. And we found a rare case of arachnoid cyst after UBE. CASE PRESENTATION A 48 years old female who had a history of cholecystectomy, nephrolithiasis, hyperthyroidism, chronic atrophic gastritis, and colonic polyps with several years of low back pain and numbness in both lower limbs was found have arachnoid cyst 3 years after UBE operation. We hope that we can give a new aspect of complication after the UBE treatment in the future. CONCLUSION We believe that the postoperative hypertension and the lack of postoperative back muscle strength training and some personal factors are the possible reasons for the arachnoid cyst in this case.
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Affiliation(s)
- Xiulong Lou
- Zhejiang Chinese Medical University, Hangzhou, China
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Penglei Chen
- Zhejiang Chinese Medical University, Hangzhou, China
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jing Shen
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jie Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuying Ge
- Zhejiang Chinese Medical University, Hangzhou, China
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - WeiFeng Ji
- Zhejiang Chinese Medical University, Hangzhou, China
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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3
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Dang R, Issagholian L, Schmidt T, Raoufi P, Neeki CC, Neeki MM. Management of traumatic cervical epidural hematoma in patients on Xa-inhibitors: a case report and review of the literature. J Med Case Rep 2023; 17:488. [PMID: 37936238 PMCID: PMC10629042 DOI: 10.1186/s13256-023-04069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/05/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Cervical epidural hematoma (CEH) is defined as a collection of blood in the suprameningeal space. Mechanisms of this rare pathology include spontaneous, postsurgical, and traumatic as the main subtypes. This unique case of traumatic CEH represents an even smaller subset of these cases. Management varies by symptom presentation, mechanism of injury, and other contraindications. CASE PRESENTATION This case presents a 32 year old African American female on an oral anticoagulant sustaining traumatic cervical hematoma after a motor vehicle collision. Patient complained of neck, abdominal, and back pain. Imaging revealed a cervical spinal hematoma at the level of C3-C6. This case discusses the management of CEH for the general population and in the setting of anticoagulation. CONCLUSION Management of each case of CEH must be carefully considered and tailored based on their symptom presentation and progression of disease. As the use of anticoagulation including factor Xa inhibitors becomes more prevalent, there is greater need to understand the detailed pathophysiological aspect of the injuries. Targeted reversal agents such as Prothrombin Concentrate can be used for conservative treatment. Adjunct testing such as thromboelastogram can be used to help guide management.
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Affiliation(s)
- Robert Dang
- Department of Emergency Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Ave, Suite # 107, Colton, CA, 92324, USA
| | - Leo Issagholian
- California University of Science and Medicine, Colton, CA, USA
| | - Tegan Schmidt
- Department of Emergency Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Ave, Suite # 107, Colton, CA, 92324, USA
| | - Pasha Raoufi
- Department of Emergency Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Ave, Suite # 107, Colton, CA, 92324, USA
| | - Cameron C Neeki
- Department of Emergency Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Ave, Suite # 107, Colton, CA, 92324, USA
| | - Michael M Neeki
- Department of Emergency Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Ave, Suite # 107, Colton, CA, 92324, USA.
- California University of Science and Medicine, Colton, CA, USA.
- Department of Surgery, Arrowhead Regional Medical Center, Colton, CA, USA.
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4
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Luo M, He M, Wu C. Prognosis and outcome of chronic pain after spontaneous spinal epidural hematoma. Acta Neurol Belg 2023; 123:1849-1854. [PMID: 36103086 DOI: 10.1007/s13760-022-02092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/01/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Chronic pain is a common symptom experienced by patients after spontaneous epidural hematoma (SSEH), and it seriously affects their quality of life. The outcome and prognosis of chronic pain after SSEH are rarely reported. Thus, we conduct this study to present the outcomes and explore prognostic factors of chronic pain in patients with SSEH. METHODS We retrospectively reviewed patients diagnosed with SSEH and invited them to complete the American Spinal Injury Association (ASIA) and Neuropathic Pain Symptom Inventory (NPSI) scales. Pearson χ2 and binary logistic regression were used to explore prognostic factors related to chronic pain after SSEH. RESULTS A total of 55 patients were reviewed; 21 patients (38.2%) were lost to follow-up, 3 patients (5.4%) died, and 31 patients (56.4%) completed the scales, with a mean follow-up time of 20.6 ± 17.3 months. The ASIA and NPSI results showed significant improvement after surgery. Pearson χ2 showed that timely surgery (≤ 12 h) was related to better outcomes (p < 0.05, Fisher test), and binary logistic regression revealed that patients with a preoperative NPSI score of 11-20 were prone to achieving significant pain relief (OR 23.67, 95%CI 1.11-503.48, p = 0.04). CONCLUSION Chronic pain is a common symptom during follow-up after SSEH, and timely intervention is suggested to obtain satisfactory outcomes. Patients who receive emergent surgery within 12 h or who have a preoperative NPSI score of 11-20 may achieve significant relief of chronic pain.
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Affiliation(s)
- Mingtao Luo
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Min He
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Cong Wu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
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Abe T, Miyazaki M, Sako N, Kanezaki S, Hirakawa M, Kawano M, Kaku N. Efficacy of gelatin-thrombin matrix sealants for blood loss in single-level transforaminal lumbar interbody fusion. Medicine (Baltimore) 2023; 102:e34667. [PMID: 37682173 PMCID: PMC10489304 DOI: 10.1097/md.0000000000034667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 09/09/2023] Open
Abstract
Although gelatin-thrombin matrix sealants have been used successfully in other surgery types, their effect on reducing blood loss during single-level transforaminal lumbar interbody fusion is unclear. We thus examined the efficacy of gelatin-thrombin matrix sealants for reducing blood loss during such surgery. We analyzed 102 patients who underwent single-level transforaminal lumbar interbody fusion for lumbar degenerative disease. We compared body mass index, surgical time, intraoperative blood loss, postoperative blood loss, true total blood loss, hidden blood loss, the proportion of blood transfusion, blood pressure pre- and post-surgery (systolic and diastolic), and pre-and post-surgery laboratory data (hemoglobin, hematocrit, platelets, prothrombin time, activated partial thromboplastin time, and D-dimer) between patients in whom gelatin-thrombin matrix sealants were (GTMS group) or were not (control group) used during surgery. One-week postoperative epidural hematoma size was measured using magnetic resonance imaging. The GTMS and control groups included 54 (24 males and 30 females) and 48 patients (19 males and 29 females). Intraoperative, true total, and hidden blood loss; epidural hematoma size; and hospitalization duration were significantly lower in the GTMS than in the control group. Intraoperative blood loss correlated with surgical time (R = 0.523, P = .001), body mass index (R = 0.221, P = .036), and the amount of gelatin-thrombin matrix sealant used (r = -0.313, P = .002). In multivariate linear regression analysis using intraoperative blood loss as the dependent variable, surgical time (standardization coefficient 0.516, P = .001) and amount of gelatin-thrombin matrix sealant used (standardization coefficient -0.220, P = .032) were independently related factors. In our study, the GTMS group had significantly less intraoperative true total and hidden blood loss than did the control group. Thus, use of gelatin-thrombin matrix sealants reduce perioperative blood loss in transforaminal lumbar interbody fusion.
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Affiliation(s)
- Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Noriaki Sako
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masashi Hirakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masanori Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Dokuzović S, Španić M, Muthu S, Pavešić J, Ivandić S, Eder G, Bošnjak B, Prodan K, Lončar Z, Ćorluka S. Conservative Treatment for Spontaneous Resolution of Postoperative Symptomatic Thoracic Spinal Epidural Hematoma-A Case Report. Medicina (Kaunas) 2023; 59:1590. [PMID: 37763709 PMCID: PMC10534765 DOI: 10.3390/medicina59091590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023]
Abstract
Introduction: Postoperative epidural hematomas of the cervical and thoracic spine can pose a great risk of rapid neurological impairment and sometimes require immediate decompressive surgery. Case Report: We present the case of a young patient operated on for stabilization of a two-level thoracic vertebra fracture who developed total paralysis due to an epidural hematoma postoperatively. The course of epidural hematoma was quickly reversed with the help of a conservative technique that prevented revision surgery. The patient regained complete neurologic function very rapidly, and has been well on every follow-up to date. Conclusion: There is a role of similar maneuvers as described in this case to be employed in the management of postoperative epidural hematomas. However, prolonged watchful waiting should still be discouraged, and patients should remain ready for revision surgery if there are no early signs of rapid recovery.
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Affiliation(s)
- Stjepan Dokuzović
- Spinal Surgery Division, Department of Traumatology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia; (S.D.); (J.P.)
- Akromion Special Hospital for Orthopaedic Surgery, 49217 Krapinske Toplice, Croatia;
| | - Mario Španić
- Akromion Special Hospital for Orthopaedic Surgery, 49217 Krapinske Toplice, Croatia;
| | - Sathish Muthu
- Orthopaedic Research Group, Coimbatore 641045, Tamil Nadu, India;
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore 641021, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur 639004, Tamil Nadu, India
| | - Jure Pavešić
- Spinal Surgery Division, Department of Traumatology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia; (S.D.); (J.P.)
| | - Stjepan Ivandić
- Traumatology Department, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia; (S.I.); (G.E.)
| | - Gregor Eder
- Traumatology Department, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia; (S.I.); (G.E.)
| | - Bogdan Bošnjak
- General Hospital, Croatian Veterans, 49210 Zabok, Croatia;
| | - Ksenija Prodan
- Clinical Department of Diagnostic and Interventional Radiology, Department of Traumatology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia;
| | - Zoran Lončar
- Anesthesiology, Intensive Care and Pain Management Division, Traumatology Department, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia;
| | - Stipe Ćorluka
- Spinal Surgery Division, Department of Traumatology, University Hospital Center Sestre Milosrdnice, 10000 Zagreb, Croatia; (S.D.); (J.P.)
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia
- Department of Anatomy and Physiology, University of Applied Health Sciences, 10000 Zagreb, Croatia
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Singh DK, Shankar D, Chandra VK. Central Dural Hitch Sutures: A Technique to Prevent Post-operative Epidural Hemorrhage in Craniotomies. Neurol India 2023; 71:1077-1078. [PMID: 37929479 DOI: 10.4103/0028-3886.388050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Deepak Kumar Singh
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Diwakar Shankar
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vipin Kumar Chandra
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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8
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Firsching R. The complicated history of the intricate relationship of posttraumatic fissures, fractures, and intracranial hematomas in neurotraumatology. Acta Neurochir (Wien) 2023; 165:2035-2036. [PMID: 37391601 PMCID: PMC10409821 DOI: 10.1007/s00701-023-05660-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/02/2023]
Affiliation(s)
- R Firsching
- Universitätsklinik Für Neurochirurgie, Leipzigerstr. 44, 39120, Magdeburg, Germany.
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9
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Johnson GW, Greenberg JK, Hale AT, Ahluwalia R, Hill M, Belal A, Baygani S, Foraker RE, Carpenter CR, Yan Y, Ackerman LL, Noje C, Jackson E, Burns EC, Sayama CM, Selden NR, Vachhrajani S, Shannon CN, Kuppermann N, Limbrick DD. Toward rational use of repeat imaging in children with mild traumatic brain injuries and intracranial injuries. J Neurosurg Pediatr 2023; 32:26-34. [PMID: 37021760 DOI: 10.3171/2023.2.peds22393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/22/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE Limited evidence exists on the utility of repeat neuroimaging in children with mild traumatic brain injuries (mTBIs) and intracranial injuries (ICIs). Here, the authors identified factors associated with repeat neuroimaging and predictors of hemorrhage progression and/or neurosurgical intervention. METHODS The authors performed a multicenter, retrospective cohort study of children at four centers of the Pediatric TBI Research Consortium. All patients were ≤ 18 years and presented within 24 hours of injury with a Glasgow Coma Scale score of 13-15 and evidence of ICI on neuroimaging. The outcomes of interest were 1) whether patients underwent repeat neuroimaging during index admission, and 2) a composite outcome of progression of previously identified hemorrhage ≥ 25% and/or repeat imaging as an indication for subsequent neurosurgical intervention. The authors performed multivariable logistic regression and report odds ratios and 95% confidence intervals. RESULTS A total of 1324 patients met inclusion criteria; 41.3% of patients underwent repeat imaging. Repeat imaging was associated with clinical change in 4.8% of patients; the remainder of the imaging tests were for routine surveillance (90.9%) or of unclear prompting (4.4%). In 2.6% of patients, repeat imaging findings were reported as an indication for neurosurgical intervention. While many factors were associated with repeat neuroimaging, only epidural hematoma (OR 3.99, 95% CI 2.22-7.15), posttraumatic seizures (OR 2.95, 95% CI 1.22-7.41), and age ≥ 2 years (OR 2.25, 95% CI 1.16-4.36) were significant predictors of hemorrhage progression and/or neurosurgery. Of patients without any of these risk factors, none underwent neurosurgical intervention. CONCLUSIONS Repeat neuroimaging was commonly used but uncommonly associated with clinical deterioration. Although several factors were associated with repeat neuroimaging, only posttraumatic seizures, age ≥ 2 years, and epidural hematoma were significant predictors of hemorrhage progression and/or neurosurgery. These results provide the foundation for evidence-based repeat neuroimaging practices in children with mTBI and ICI.
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Affiliation(s)
| | | | - Andrew T Hale
- 2Department of Neurological Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Ranbir Ahluwalia
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Madelyn Hill
- 4Department of Neurological Surgery, Dayton Children's Hospital, Dayton, Ohio
| | - Ahmed Belal
- 5Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Shawyon Baygani
- 5Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | - Yan Yan
- 8Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Laurie L Ackerman
- 5Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Eric Jackson
- 10Neurological Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Christina M Sayama
- 12Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Nathan R Selden
- 12Neurological Surgery, Oregon Health & Science University, Portland, Oregon; and
| | - Shobhan Vachhrajani
- 4Department of Neurological Surgery, Dayton Children's Hospital, Dayton, Ohio
| | - Chevis N Shannon
- 2Department of Neurological Surgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Nathan Kuppermann
- Departments of13Emergency Medicine and
- 14Pediatrics, University of California, Davis, School of Medicine, Sacramento, California
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10
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Greenberg JK, Olsen MA, Johnson GW, Ahluwalia R, Hill M, Hale AT, Belal A, Baygani S, Foraker RE, Carpenter CR, Ackerman LL, Noje C, Jackson EM, Burns E, Sayama CM, Selden NR, Vachhrajani S, Shannon CN, Kuppermann N, Limbrick DD. Measures of Intracranial Injury Size Do Not Improve Clinical Decision Making for Children With Mild Traumatic Brain Injuries and Intracranial Injuries. Neurosurgery 2022; 90:691-699. [PMID: 35285454 PMCID: PMC9117421 DOI: 10.1227/neu.0000000000001895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND When evaluating children with mild traumatic brain injuries (mTBIs) and intracranial injuries (ICIs), neurosurgeons intuitively consider injury size. However, the extent to which such measures (eg, hematoma size) improve risk prediction compared with the kids intracranial injury decision support tool for traumatic brain injury (KIIDS-TBI) model, which only includes the presence/absence of imaging findings, remains unknown. OBJECTIVE To determine the extent to which measures of injury size improve risk prediction for children with mild traumatic brain injuries and ICIs. METHODS We included children ≤18 years who presented to 1 of the 5 centers within 24 hours of TBI, had Glasgow Coma Scale scores of 13 to 15, and had ICI on neuroimaging. The data set was split into training (n = 1126) and testing (n = 374) cohorts. We used generalized linear modeling (GLM) and recursive partitioning (RP) to predict the composite of neurosurgery, intubation >24 hours, or death because of TBI. Each model's sensitivity/specificity was compared with the validated KIIDS-TBI model across 3 decision-making risk cutoffs (<1%, <3%, and <5% predicted risk). RESULTS The GLM and RP models included similar imaging variables (eg, epidural hematoma size) while the GLM model incorporated additional clinical predictors (eg, Glasgow Coma Scale score). The GLM (76%-90%) and RP (79%-87%) models showed similar specificity across all risk cutoffs, but the GLM model had higher sensitivity (89%-96% for GLM; 89% for RP). By comparison, the KIIDS-TBI model had slightly higher sensitivity (93%-100%) but lower specificity (27%-82%). CONCLUSION Although measures of ICI size have clear intuitive value, the tradeoff between higher specificity and lower sensitivity does not support the addition of such information to the KIIDS-TBI model.
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Affiliation(s)
- Jacob K. Greenberg
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA;
| | - Margaret A. Olsen
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA;
| | - Gabrielle W. Johnson
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA;
| | - Ranbir Ahluwalia
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
| | - Madelyn Hill
- Division of Neurosurgery, Dayton Children's Hospital, Dayton, Ohio, USA;
| | - Andrew T. Hale
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA;
| | - Ahmed Belal
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA;
| | - Shawyon Baygani
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA;
| | - Randi E. Foraker
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA;
| | - Christopher R. Carpenter
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA;
| | - Laurie L. Ackerman
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA;
| | - Corina Noje
- Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Critical Care Medicine, The Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Eric M. Jackson
- Neurological Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA;
| | - Erin Burns
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA;
| | - Christina M. Sayama
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA;
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA;
| | - Nathan R. Selden
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA;
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA;
| | - Shobhan Vachhrajani
- Division of Neurosurgery, Dayton Children's Hospital, Dayton, Ohio, USA;
- Department of Pediatrics, Wright State University, Dayton, Ohio, USA;
| | - Chevis N. Shannon
- Division of Neurosurgery, Dayton Children's Hospital, Dayton, Ohio, USA;
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California Davis, School of Medicine, Sacramento, California, USA;
- Department of Pediatrics, University of California Davis, School of Medicine, Sacramento, California, USA
| | - David D. Limbrick
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA;
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Sun XY, Yang QF, Zhu YL, Wang YB, Dong HW, Yang MZ, Tian ZL, Wan L, Zou DH, Yu XT, Liu NG. Logistic Regression Analysis of the Mechanism of Blunt Brain Injury Inference Based on CT Images. Fa Yi Xue Za Zhi 2022; 38:217-222. [PMID: 35899510 DOI: 10.12116/j.issn.1004-5619.2021.410809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To study the correlation between CT imaging features of acceleration and deceleration brain injury and injury degree. METHODS A total of 299 cases with acceleration and deceleration brain injury were collected and divided into acceleration brain injury group and deceleration brain injury group according to the injury mechanism. Subarachnoid hemorrhage (SAH) and Glasgow coma scale (GCS), combined with skull fracture, epidural hematoma (EDH), subdural hematoma (SDH) and brain contusion on the same and opposite sides of the stress point were selected as the screening indexes. χ2 test was used for primary screening, and binary logistic regression analysis was used for secondary screening. The indexes with the strongest correlation in acceleration and deceleration injury mechanism were selected. RESULTS χ2 test showed that skull fracture and EDH on the same side of the stress point; EDH, SDH and brain contusion on the opposite of the stress point; SAH, GCS were correlated with acceleration and deceleration injury (P<0.05). According to binary logistic regression analysis, the odds ratio (OR) of EDH on the same side of the stress point was 2.697, the OR of brain contusion on the opposite of the stress point was 0.043 and the OR of GCS was 0.238, suggesting there was statistically significant (P<0.05). CONCLUSIONS EDH on the same side of the stress point, brain contusion on the opposite of the stress point and GCS can be used as key indicators to distinguish acceleration and deceleration injury mechanism. In addition, skull fracture on the same side of the stress point, EDH and SDH on the opposite of the stress point and SAH were relatively weak indicators in distinguishing acceleration and deceleration injury mechanism.
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Affiliation(s)
- Xue-Yang Sun
- Department of Forensic Medicine, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450000, China
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
| | - Qi-Fan Yang
- Department of Forensic Medicine, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450000, China
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
| | - Yun-Liang Zhu
- Department of Forensic Medicine, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450000, China
| | - Yan-Bin Wang
- China National Accreditation Service for Conformity Assessment, Beijing 100062, China
| | - He-Wen Dong
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
| | - Ming-Zhen Yang
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
| | - Zhi-Ling Tian
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
| | - Lei Wan
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
| | - Dong-Hua Zou
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
| | - Xiao-Tian Yu
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
| | - Ning-Guo Liu
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
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Bliss A, Cox D, Chaulk D. Oculocardiac Reflex in A 15-Year-Old With Orbital Fractures and Epidural Hematoma. Pediatr Emerg Care 2021; 37:e675-e676. [PMID: 32701866 DOI: 10.1097/pec.0000000000002191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The oculocardiac reflex has been well described in the literature and was first defined in 1908 by Aschner. The phenomenon involves the afferent limb of the ophthalmic division of the trigeminal nerve as well as the efferent pathway involving the vagal nerve leading to negative chronotropic effects. It results in a decrease in heart rate and oftentimes a decrease in blood pressure associated with compression of the eye or traction of the extraocular muscles. This reflex has clinical significance in both the operating room during ophthalmic procedures and in the emergency department in patients having sustained craniofacial trauma. The typical dysrhythmia described in literature is sinus bradycardia. Our patient, however, had a ventricular escape rhythm with a complete left bundle branch block pattern.
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Affiliation(s)
- Amy Bliss
- From the Northern Nevada Emergency Physicians, Renown Regional Medical Center, Reno, NV
| | - Daniel Cox
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - David Chaulk
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, UT
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Finneran JJ, Cozart B, Ilfeld BM, Said ET. Comparison of thoracic epidural hematoma visualized by computed tomography versus magnetic resonance imaging. Can J Anaesth 2021; 68:918-920. [PMID: 33725317 PMCID: PMC8163669 DOI: 10.1007/s12630-021-01963-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 12/05/2022] Open
Affiliation(s)
- John J Finneran
- Department of Anesthesiology, University of California San Diego, San Diego, CA, USA.
- Outcomes Research Consortium, Cleveland, OH, USA.
| | - Bryan Cozart
- School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Brian M Ilfeld
- Department of Anesthesiology, University of California San Diego, San Diego, CA, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Engy T Said
- Department of Anesthesiology, University of California San Diego, San Diego, CA, USA
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Kato D, Terae S. [Cervical Spinal Epidural Hematoma]. No Shinkei Geka 2021; 49:356-361. [PMID: 33762457 DOI: 10.11477/mf.1436204398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A woman in her 60s was admitted to our hospital because of sudden-onset right hemiparesis, paresthesia, and neck pain. At first, a head CT scan was performed to rule out stroke, which did not detect any abnormalities. Subsequently, a neck CT scan was performed, which revealed a mild high-density structure compressing the dural sac within the cervical spinal canal. She was suspected to have a spinal hematoma. A MRI scan revealed a spindle-shaped structure with a heterogeneous high signal on T2-weighted and a mild high signal on T1-weighted sagittal images, which led to the diagnosis of a spontaneous spinal epidural hematoma. The patient was treated with conservative therapy upon which her symptoms improved. She was discharged seven days after admission. Spontaneous cervical spinal epidural hematoma often causes neck pain followed by unilateral spinal cord compression symptoms(such as hemiparesis and paresthesia)and can be misdiagnosed as a stroke. In cases of hemiparesis with sudden-onset neck pain, cervical lesions should be considered in the differential diagnoses in addition to stroke.
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Affiliation(s)
- Daisuke Kato
- Department of Diagnostic Radiology, Sapporo City General Hospital
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15
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Nguyen M, Williams SR, Gagné JF. Epidural hematoma following epidural catheter removal after a single dose of clopidogrel. Can J Anaesth 2020; 67:390-391. [PMID: 31583579 DOI: 10.1007/s12630-019-01495-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Micheline Nguyen
- Department of Anesthesiology and Pain Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Stephan R Williams
- Department of Anesthesiology and Pain Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Jean-François Gagné
- Department of Anesthesiology and Pain Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.
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Ekşi MŞ. Are we still missing important amount of data through meta-analyses?: a letter to the editor regarding the article by Soltani et al. published in the European Spine Journal about spontaneous spinal epidural hematomas in children. Childs Nerv Syst 2020; 36:227. [PMID: 31853897 DOI: 10.1007/s00381-019-04444-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/19/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Murat Şakir Ekşi
- Department of Neurosurgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.
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Ganz JC. Letter: Transarterial N-Butyl-2-cyanoacrylate Embolization of an Intraosseous Dural Arteriovenous Fistula Associated With Acute Epidural Hematoma: Technical Case Report. Oper Neurosurg (Hagerstown) 2017; 13:E1. [PMID: 28927216 DOI: 10.1093/ons/opx001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 08/31/2016] [Indexed: 11/13/2022] Open
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Yoshioka S, Satomi J, Nagahiro S. In Reply: Transarterial N-Butyl-2-cyanoacrylate Embolization of anIntraosseous Dural Arteriovenous FistulaAssociated With Acute Epidural Hematoma:Technical Case Report. Oper Neurosurg (Hagerstown) 2017; 13:E2-E3. [PMID: 28927225 DOI: 10.1093/ons/opx003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 09/23/2016] [Indexed: 11/13/2022] Open
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Steinbok P. Letter to the editor re: citations for the literature on spontaneous spinal epidural hematoma by Babayev et al. (2016). Childs Nerv Syst 2016; 32:1019. [PMID: 27112354 DOI: 10.1007/s00381-016-3083-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/05/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Paul Steinbok
- Division of Neurosurgery, BC Children's Hospital and University of British Columbia, 4480 Oak St., Room K3-159, Vancouver, BC, V6h 3V4, Canada.
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Affiliation(s)
- Prasad Krishnan
- Department of Neurosurgery, National Neurosciences Centre, Peerless Hospital Complex, Kolkata, West Bengal, India
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Khan MB, Riaz M, Javed G. Conservative management of significant supratentorial epidural hematomas in pediatric patients. Childs Nerv Syst 2014; 30:1249-53. [PMID: 24668144 DOI: 10.1007/s00381-014-2391-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/17/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radiologically significant epidural hematomas are generally treated with craniotomy and evacuation. However, pediatric patients with such hematomas may have normal neurological examinations. We aim to report the presenting features, management, and outcomes of pediatric patients who underwent conservative management of such hematomas at our center and also show that serial neurological examinations are a safe and effective way of managing these patients. METHODS A retrospective review of pediatric patients with extradural hematoma (EDH) thickness of at least 1 cm and who were conservatively managed was performed. All patients were followed up in neurosurgery outpatient clinics after discharge at 1-month, 3-month, 6-month, and 1-year intervals. Detailed neurological examination was performed at each visit, and a standardized questionnaire was also used to document the parent's subjective opinion of the patient's quality of life. RESULTS A total of 17 patients satisfied the study criteria and were included. Conservative management was successful in 15 patients, while a craniotomy with evacuation of hematoma had to be performed in two patients. All patients had a GOS score of 5 on 1-year follow-up, had normal schooling, and reported complete satisfaction with the management protocol. CONCLUSION Conservative treatment is an optimal treatment option, and patients can be followed safely using a protocol of serial neurological examinations. A center must have resources to perform a craniotomy with evacuation of EDH in case of neurological worsening and be able to provide trained staff to carry out serial neurological examinations before treating these patients conservatively.
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Affiliation(s)
- Muhammad Babar Khan
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan,
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Abstract
BACKGROUND CONTEXT Many cases of nontraumatic spinal epidural hematoma (SEH) have been reported, although the etiology of SEH remains unclear. PURPOSE Our purpose was to report a rare case of nontraumatic acute SEH caused by extradural varices and to discuss the etiology of this entity. STUDY DESIGN/SETTING Case report. PATIENT SAMPLE A 27-year-old man. OUTCOME MEASURES Resolution of the patient's paraplegia, and pathological examination of the epidural vein of the patient and three other patients with cervical spondylosis. METHODS Not applicable. RESULTS The patient recovered from paresis of both hands, although paraplegia remains complete. Pathological examination of the patient revealed abnormal veins that had thickened walls, varying caliber, and internal elastic lamina. In two of the three patients with cervical spondylosis, abnormally dilated veins resembling those in the SEH patient were observed. CONCLUSIONS We describe a rare case of SEH caused by extradural varices. It is speculated that spinal epidural veins can possibly develop an abnormal structure and fragility as seen in the present case and in spondylotic cases.
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Affiliation(s)
- Hiroyoshi Akutsu
- Department of Neurosurgery, Mito National Hospital, Ibaraki, Japan.
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Maeda M, Kosaka Y, Kushizaki H, Yamamori Y, Hashimoto K, Saito Y. [Safety of continuous epidural anesthesia during heart surgery--change of coagulation-fibrinolysis under heparinization]. Masui 1999; 48:723-30. [PMID: 10434512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
To confirm the safety of continuous epidural anesthesia during extracorporeal circulation under heparinization, we investigated epidural hematoma formation following the cardiopulmonary bypass in both humans and dogs. In fifteen dogs, divided into three groups, heparin was administered at the dose of 300, 600, or 900 U.kg-1, respectively. In fourteen patients, a dose of 300 U.kg-1 haparin was administered for cardiopulmonary bypass. Although blood coagulation-fibrinolysis dropped into abnormal ranges following heparinization, no epidural hematoma was observed in dog and no patient revealed spinal complication associated with epidural hematoma. These data indicate that continuous epidural anesthesia would be a safe tool for intraoperative anesthesia even during extracorporeal circulation under heparinization.
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Affiliation(s)
- M Maeda
- Department of Anesthesiology, Shimane Medical University, Izumo
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Ng PC. Laparoscopic gastrostomy: a simple way to feed. Surg Laparosc Endosc Percutan Tech 1994; 4:463-4. [PMID: 7866620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A simple two-puncture method of performing laparoscopic gastrostomy under local anesthetic and sedation is described. The advantages are direct visualization at all times and the safe and rapid insertion of a large-bore tube with minimal discomfort to the patient. No special equipment is required except a basic laparoscopic set.
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Affiliation(s)
- P C Ng
- Department of Surgery, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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de Tovar G, Akerman M. [Echography and cerebral gammagraphy in craniofacial injuries]. Rev Stomatol Chir Maxillofac 1976; 77:901-7. [PMID: 1070106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The authors review the aid provided and sometimes essential nature of echographic and isotopic studies in cranio-facial trauma when seeking neurological complications -in particular intracranial haematomas and cerebrospinal fluid fistulas. They describe the principles of each of these technics, their indications, performance and limitations. These examinations are simple, rapid and perfectly harmless but must be carried out in specialised departments, which limits their use.
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Revuelta M, Barrionuevo B, Rubio E, Jos VL. [Spontaneous spinal epidural haematoma (author's transl)]. Rev Esp Otoneurooftalmol Neurocir 1974; 32:7-12. [PMID: 4842885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Wolf G. [Spontaneous intracranial hemorrhage. Symptoms, prognosis and therapy]. Med Welt 1971; 14:523-32. [PMID: 4928112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Liguori R, Troisi F. [Calcified extracerebral hematoma following a skull decrompression operation]. Rass Int Clin Ter 1968; 48:1480-1485. [PMID: 5737745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Verjaal A. [Intracranial hemorrhages]. Tijdschr Ziekenverpl 1968; 21:974-7. [PMID: 5191136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Liguori R, Profeta G. [Atypical extradural hematomas]. Rass Int Clin Ter 1968; 48:1461-8. [PMID: 5737743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Merli GA, Mingrino S. [Post-traumatic extradural hematomas of the posterior cranial fossa]. Chir Ital 1968; 20:1840-52. [PMID: 5201370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Pizio Z, Arct W. [Atypical chronic traumatic hematomas]. Wiad Lek 1968; 21:1073-5. [PMID: 5667181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Longo V. [Skull injuries in sports]. Folia Med (Napoli) 1968; 51:165-74. [PMID: 5736900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Pudenz RH. Seminar on the management of head injuries. Extradural hemorrhage. Ariz Med 1968; 25:193-9. [PMID: 5638814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Quéloz JM. [Epidural hematoma in children]. Praxis 1968; 57:431-439. [PMID: 5756339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Brown RS, Mohr PA, Carey JS, Shoemaker WC. Cardiovascular changes after cranial cerebral injury and increased intracranial pressure. Surg Gynecol Obstet 1967; 125:1205-11. [PMID: 6065257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Likhterman LB, Khitrin LK. [Epidural hematoma in the polar region of the frontal lobe]. Vestn Khir Im I I Grek 1967; 98:99-100. [PMID: 5609156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Casella E, Chiappetta F, Chiasserini A, Gazzeri G. [Clinico-statistical considerations on 150 cases of cerebral lacerations]. Minerva Neurochir 1967; 11:154-157. [PMID: 5612824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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