Outcomes of 8 × 8 mm osteotomy in powered external dacryocystorhinostomy

Purpose: To study the endoscopic ostium characteristics and outcome of 8 × 8 mm osteotomy in external dacryocystorhinostomy (DCR) using the microdrill system. Methods: This prospective interventional pilot study was performed on 40 eyes of 40 patients with primary acquired nasolacrimal duct obstruction (NLDO) from June 2021 to September 2021 in patients undergoing external DCR. An 8 × 8 mm osteotomy was performed using round, cutting burr attached to a microdrill system. Success was defined as patent ostium on lacrimal syringing (anatomical) and a Munk score <3 (functional) at 12 months. Postoperative endoscopic ostium evaluation was done using a modified DCR ostium (DOS) scoring system at 12 months. Results: The mean age of the study participants was 42.41 ± 11.77 years and the male?to?female ratio was 1:4. The mean duration of surgery was 34.15 ± 1.66 minutes and that for osteotomy creation was 2.5 ± 0.69 minutes. The mean intraoperative blood loss was 83.37 ± 11.89 ml. Anatomical and functional success rates were 95% and 85%, respectively. The mean modified DOS score was “excellent” in 34 patients (85%), “good” in 1 patient (2.5%), “fair” in 4 patients (10%), and “poor” in 1 patient (2.5%). Complications included nasal mucosal injury in 10% (4/40) of patients, complete cicatricial closure of ostium in 2.5% (1/40), incomplete cicatricial closure in 10% (4/40), nasal synechiae in 5% (2/40), and canalicular stenosis in 2.5% (1/40). Conclusion: An 8 × 8 mm–sized osteotomy created by powered drill and covered by lacrimal sac–nasal mucosal flap anastomosis in external DCR is an effective technique that has minimal complications and shorter surgical time

A case of stage Ⅲ pneumoconiosis with large shadow by burr-like changes misdiagnosed as lung cancer / 中华劳动卫生职业病杂志

Pneumoconiosis is characterized by chronic lung inflammation and fibrosis, and inflammation can promote pulmonary fibrosis, which in turn leads to pneumoconiosis. When a large shadow with a long diameter of not less than 2 cm and a short diameter of not less than 1 cm appears in the lung, it can be classified as stage Ⅲ pneumoconiosis. This paper reports a case of stage Ⅲ pneumoconiosis with a large shadow in the upper right lung accompanied by burr-like changes misdiagnosed as lung cancer by CT examination.When the large shadow lesions in patients with pneumoconiosis and lung cancer are difficult to distinguish on CT, an additional MRI examination, particularly T(2)W imaging sequence is useful sequence for identifying the two.

Management of intrascleral chestnut burr spines under ultrasound biomicroscopy guidance

Purpose: To explore the efficacy of ultrasound biomicroscopy (UBM) as a tool for detecting and localizing intrascleral chestnut burr spines. Methods: Individuals who were diagnosed with definitive or suspected intrascleral chestnut burr injuries between 2019 and 2020 were retrospectively reviewed. All patients underwent UBM to detect potential intrascleral spines. UBM imaging features were recorded and analyzed. Intrascleral spines were removed based upon UBM?guided localization. Patient clinical profiles, management, and treatment outcomes were recorded. Results: A total of 10 eyes (10 patients; 6 males, 4 females) were diagnosed with intrascleral spines over the study period, with an average patient age of 55 years (range: 39–71). Three of these 10 eyes exhibited involvement of the palpebrae and cornea, whereas three exhibited corneal involvement, and the remaining four patients exhibited only intrascleral spine injuries owing to their having undergone previous intracorneal spine extraction procedures. UBM features consistent with chestnut burr spines manifest a hyperechoic spot with a shadow. UBM enabled the precise localization of these spines and thus ensured their successful removal via a single surgery. During follow?up, two patients experienced vitreous hemorrhage due to a penetrating injury into the ciliary body that was gradually absorbed. All patients with eye irritation and red eyes progressed favorably, and no surgical complications were recorded. Conclusion: A retained scleral chestnut burr spine should be suspected if a patient complains of persistent eye irritation following intracorneal spine removal. UBM may be a valuable tool for detecting spines retained in the sclera, enabling the successful removal thereof.

Clinical study of Xuefu Zhuyu Capsule combined with drilling and drainage in the treatment of chronic subdural hematoma / 中国医师进修杂志

Objective:To identify the effects of Xuefu Zhuyu Capsule (XZC) on the surgical treatment of patients with chronic subdural hematoma (CSDH).Methods:Retrospectively collected 96 pairs of patients who undergoing burr-hole craniotomy (BHC) for CSDH from January 2016 to December 2019 in Dalian Municipal Central Hospital. Clinical characteristics and imaging information of each patient were extracted, the follow-up period was six months. Differences in demographics and postoperative outcomes were compared between BHC+XZC group and BHC only group. Univariate analysis and multivariate analysis with Logistic regression model were performed to determine independent associations among the various probable effective factor. The relationship between related factors and effectiveness of CSDH was estimated with odds ratio ( OR) and 95% CI. Results:Effectiveness in 87 cases (90.6%) patients with surgery and received XZC postoperatively was significantly higher than 76 cases (79.2%) patients who underwent surgery alone. Multivariate Logistic regression analysis showed postoperative administration of XZC and preoperative Glasgow coma scale (GCS) score were independent protective factors for CSDH to improve therapeutic effect.Conclusions:This study suggested postoperative administration of XZC for CSDH patients can improve the therapeutic effect, a higher preoperative GCS score is contributed to the postoperative effect.

Localización preoperatoria de la trepanación inicial en el abordaje retrosigmoideo. Revisión de literatura y aplicación quirúrgica / Preoperative location of the initial trepanation in the retrosigmoid approach. Literature review and surgical application

Objetivo: Evaluar una técnica eficaz y reproducible que permita determinar el sitio de la trepanación inicial en el abordaje retrosigmoideo. Materiales y métodos: Se empleó una muestra de 22 pacientes a fin de analizar la relación de la transición transverso ­ sigmoidea (TTS) con el asterion y la ranura digástrica. Todos los casos contaban con TC de cortes finos (1 mm de espesor). Se subdividieron los pacientes en dos grupos. Grupo 1: pacientes con patologías variables, sin alteraciones estructurales en la fosa posterior. Grupo 2: pacientes en los que se realizó un abordaje retrosigmoideo con planificación prequirúrgica del sitio de trepanación inicial. Discusión: Las referencias óseas (asterion y punto digástrico) pudieron identificarse en la totalidad de las TC 3D analizadas. Se analizaron las distancias empleando un sistema de coordenadas. La TTS se registró en el 78% de los casos anterior e inferior al asterion. En ningún caso se encontró la TTS superior al asterion, la ubicación en sentido inferior varió entre 0 mm y 25,5 mm (media 12,5 mm). En el plano anteroposterior, se registró una distancia entre -6,41 mm y 14,5 mm (media 4,09 mm), demostrando una gran variabilidad individual, comparable con lo descripto en la literatura. En el grupo 2, pudo predecirse de manera precisa la localización de la TTS, exponiendo la misma con la trepanación inicial. Conclusión: Se describe un método sencillo, eficaz, de libre acceso, que permite la ubicación del keyhole en el abordaje retrosigmoideo

Objective: To assess an effective and reproducible technique that allows determining the emplacement of the initial burr-hole in the retrosigmoid approach. Materials and methods: A sample of 22 patients was used to analyze the relation among the transverse - sigmoid transition (TTS), the asterion and the digastric groove. All cases had a thin-slice, 1-mm-thick Computed Tomography (CT). Patients were subdivided into two groups. Group 1: patients with variable pathologies, without structural modification of posterior fossa anatomy. Group 2: patients in which a retrosigmoid approach was performed with preoperative surgical planning of the initial burr-hole. Discussion: Bone references (asterion and digastric point) could be identified in the totality of the analyzed 3D CT. The distances were measured using a coordinate system. TTS was recorded in 78% of the cases inferior and anterior to the asterion. In no case the TTS was found superior to the asterion. It was 0 mm to 25.5 mm (mean 12.5 mm) inferior; and a distance between -6.41mm to 14.5mm (mean 4.09mm) in the anteroposterior plane was recorded, demonstrating a large individual variability. In group 2, the location of the TTS could be accurately predicted, exposing it with the initial burr-hole. Conclusion: A simple, effective and access free method is described, which allows the emplacement of the keyhole in the retrosigmoid approach

Clinical outcomes following surgical management of brain abscess in a tertiary care centre: retrospective analysis of 56 cases

Background: Despite the advent of newer antibiotics and surgical strategies, the overall outcome and quality of life issues in Brain Abscess (BA) patients remain a continuous challenge for the neurosurgical community.Methods: Fifty-six patients with BA are analyzed retrospectively, that treated between January 2014 and June 2019, according to age, the clinical symptoms, etiologic factors, infecting organisms, prognostic factors, localization, diagnostic and treatment methods and outcome.Results: In acute cases, common clinical features were headache, fever, vomiting, focal deficit and seizure. In chronic abscesses, common clinical features were mild to moderate headache and progressive focal deficit. In 12(21.42%) patients had adjacent localized sinus, middle ear infection. In 27(48.21%) patients no primary source of infection was identified, predisposing factors included post neurosurgery (8.92%), post penetrating injury (3.57%), and congenital heart disease, infective endocarditis, sinusitis. The frontal lobe involved in 28.5% cases, temporal lobe and cerebellum are next to be involved. Burr hole aspiration in 29(51.78%) cases, a craniotomy was done in 15(26.78%) cases. Pus culture was negative in 36 (64.28%) cases. Mortality was noted in 2(3.57%) cases. Complete resolution of the abscess with complete recovery of preoperative neuro-deficit was seen in 71.42% cases and recovery with major neuro-deficit was observed in 16.07% cases. The best outcome was seen with a better Glasgow Coma Scale (GCS) on admission.Conclusions: BA, when surgery is required, should be done on an emergency basis. BA treated with burr hole aspiration shows excellent clinical and radiological response. A craniotomy is required in selected cases and is a primary procedure in cerebellar, postoperative and posttraumatic abscesses. Broad-spectrum antibiotic therapy should be administered for a period of minimum 6 weeks to prevent relapse.

Subperiosteal Drainage versus Subdural Drainage in the Management of Chronic Subdural Hematoma (A Comparative Study)

Introduction: Symptomatic chronic subdural hematomas (CSDH) remain one of the most frequent diagnoses in current neurosurgical practice. Burr-hole craniostomy with irrigation and placement of close-system drainage is the current recommended surgery for symptomatic CSDH. The aim of this study is to perform a direct comparison between two surgical techniques in the treatment of symptomatic CSDH, which have been proven in previous studies to be efficient. Our main objective was to compare the efficacy of placement of a subperiosteal drain (SPD) and a subdural drain (SDD) following single burr-hole craniostomy and irrigation, and to demonstrate any significant differences in terms of overall surgical complications, functional outcome at three months and mortality rate. Materials and Methods: The study was carried out in two local neurosurgical centres. The SPD group was performed in Hospital Umum Sarawak (HUS) and the SDD group was performed in Hospital Sultanah Aminah Johor Bahru (HSAJB), from 1 January 2012 till 30 January 2014 with a total of 30 patients in both treatment groups. Results: Overall, there were no statistically significant difference in terms of patient general characteristics, pre-operative and post-operative symptoms, Markwalder grades, postoperative hematoma volume and recurrence, mortality and functional outcome at discharge and at three month follow-up between both groups. Albeit not achieving statistical significance, we observed a lower rate of surgical complication especially for post-operative intracranial hematoma with placement of the SPD system. Conclusions: Our study concludes that both treatment methods proved to be highly effective in the treatment of CSDH. However, with a lower overall surgical complication rate, treatment with single burr-hole craniostomy, irrigation and placement of the SPD system can be considered a treatment of choice for the management of symptomatic CSDH.

The effect of the combination of dexmedetomidine and sufentanil on monitoring anesthesia care during burr-hole surgery for patients with chronic subdural hematoma / 实用医学杂志

Objective To evaluate the effect of the combination of dexmedetomidine and sufentanil on monitoring anesthesia care during burr-hole surgery for patients with chronic subdural hematoma. Methods 96 pa-tients underwent burr-hole surgery for chronic subdural hematoma with MAC were randomly divided into two groups:Group D and Group DS (n=48 in each group). Local anesthetic block was started at least 10 min after DEX and sufentanil infusion. Ramsay sedation scale of the two groups was maintained to 3. Anesthesia onset time, hemo-dynamics, the amount of rescue midazolam or fentanyl, the time to first dose of rescue midazolam or fentanyl, the to-tal number of intraoperative patient movements, postoperative recovery time, patient and surgeon satisfaction scores, and the adverse events were recorded. Results Compared with group D, anesthesia onset time was significantly less in group DS (13.68 ± 3.13 vs. 11.82 ± 2.43 min, P=0.002). More patients in group D required rescue midazol-am to achieve RSS=3 compared with group DS (31.25%15/48 vs. 12.50%6/48, P=0.023). Compared with group D, significantly fewer patients in group DS required rescue fentanyl to relieve pain (10.42%5/48 vs. 27.08%13/48, P = 0.036). Additionally, the total dose of rescue fentanyl in group DS was significantly higher (89.48 ± 23.27 vs. 125.28 ± 33.52μg, P=0.000), and the time to first dose of rescue fentanyl was longer than group D(18.34 ± 4.45 vs. 14.34 ± 3.63 min, P=0.000). The total number of patient movements during the burr-hole surgery was higher in group D than group DS (35.42%17/48 vs. 16.67%8/48, P=0.036). The time to recovery for discharge from the PA-CU (time to an Aldrete score ≥ 9) was significantly shorter in group DS compared with group D (17.54 ± 5.92 vs. 12.57 ± 5.28 min, P=0.000). Results from the patient and surgeon satisfaction scores showed significant differenc-es favoring group DS (P<0.05). More patients in group D showed higher levels of the overall incidence of bradycar-dia (37.50% 18/48 vs. 18.75% 9/48, P = 0.041) and hypotension(37.50%18/48 vs. 14.58%79/48, P=0.011)com-pared with group DS. Conclusions Compared with DEX alone, DEX-sufentanil associated with fewer number of in-traoperative patient movements, less amount of rescue scheme, could be safely and efficiently used for MAC during burr-hole surgery for patients with chronic subdural hematoma.

Remote Hemorrhage after Burr Hole Drainage of Chronic Subdural Hematoma / 대한신경손상학회지

Chronic subdural hematoma (CSDH) and symptomatic subdural hygroma are common diseases that require neurosurgical management. Burr hole trephination is the most popular surgical treatment for CSDH and subdural hygroma because of a low recurrence rate and low morbidity compared with craniotomy with membranectomy, and twist-drill craniotomy. Many reports suggest that placing a catheter in the subdural space for drainage can further reduce the rate of recurrence; however, complications associated with this type of drainage include acute subdural hematoma, cortical injury, and infection. Remote hemorrhage due to overdrainage of cerebrospinal fluid (CSF) is another possible complication of burr hole trephination with catheter drainage that has rarely been reported. Here, we present 2 cases of remote hemorrhages following burr hole trephination with catheter drainage for the treatment of CSDH and symptomatic subdural hygroma. One patient developed intracerebral hemorrhage and subarachnoid hemorrhage in the contralateral hemisphere, while another patient developed remote hemorrhage 3 days after the procedure due to the sudden drainage of a large amount of subdural fluid over a 24-hour period. These findings suggest that catheter drainage should be carefully monitored to avoid overdrainage of CSF after burr hole trephination.

Hematomas subdurales subagudos: ¿solo dos trépanos? / Subacute subdural hematomas: only two drills?

Objetivo: Comparar la evolución postoperatoria de los hematomas subdurales subagudos (HSDSA) y hematomas subdurales crónicos (HSDC) intervenidos con técnica de 2 trépanos, desde junio 2013 a junio 2015. Material y métodos: Se realizó un análisis prospectivo comparando 2 grupos de pacientes: HSDSA y HSDC. Ambos fueron tratados con la misma técnica quirúrgica: dos orificios de trepano, lavado y drenajes subdurales. Se analizaron y compararon: tiempo de cirugía, resolución de los síntomas, necesidad de re-intervención y días de internación. Las variables se presentan como media y DS y mediana y RI, las comparaciones se realizaron con test o Chi2 según su naturaleza, una p <0.05 se considero significativa. Resultados: Fueron evaluados 66 pacientes, 30 HSDSA y 36 HSDC. La edad fue 75 ±11 años (HSDA 76± 11 y HSDC 74 ±12, p 0.5), masculinos 66% (HSDSA 50% y HSDC 85%, p 0.006). El tiempo medio de cirugía para HSDSA fue 59±12 y HSDC 59±17 minutos, p 0.9. Resolvieron la sintomatología en HSDSA 28 (93,3%) y HSDC 34 (94,4%), p 0.8; y requirieron una segunda cirugía por recidiva HSDSA 2 (6,7%) y HSDC 2 (5,6%), p 0.6. La mediana del tiempo de internación fue HSDSA 10 [9- 12] días y HSDC 7,5 [6-10] días, p 0.01. La sobrevida fue del 100%. Conclusiones: La trepanación es una técnica ampliamente aceptada para el tratamiento de HSDC. En hematomas subdurales agudos no existe discusión sobre la necesidad de realizar un abordaje mayor (craneotomía o craniectomía). En el caso de HSDSA la evidencia publicada no es tan concluyente tendiendo en muchos centros a tratarlos en forma similar a los hematomas subdurales agudos generalmente por considerar que la técnica de trepanación y drenaje podría ser insuficiente. Basado en los resultados obtenidos en el presente trabajo podemos concluir que esta técnica es igualmente efectiva para el tratamiento de HSDC y HSDSA y recomendamos su utilización sistemática.

Objective: To compare the postoperative course of subacute subdural hematomas (SSDH) and chronic subdural hematoma (CSDH) operated upon using two burr holes from June 2013 to June 2015. Methods: A prospective analysis was performed comparing patients with SSDH versus CSDH. Both were treated with the same surgical technique —two burr holes— followed by lavage and subdural drainage. Variables compared were surgery time, resolution of symptoms, the need for re-intervention, and number of inpatient days. Variables are presented as means with SD, medians and range, with statistical comparisons performed via Pearson χ2 analysis or XXXXXXXX, as appropriate, with p <0.05 considered significant. Results: A total of 66 patients were analyzed, 30 with SSDH and 36 with CSDH. Mean overall age was 75 ± 11 years with no difference between the two groups (76 ± 11 versus 74 ± 12, respectively; p=0.5). Overall, 66% were male, including 50% with SSDH and 85% with CSDH (p = 0.006). The average lengths of surgery were 59 ± 12 versus 59 ± 17 minutes, respectively (p = 0.9). No intergroup differences were noted in the rate of symptom resolution (93.3% versus 94.4%; p = 0.8) or need for a second surgery for disease recurrence (6.7% vs. 5.6%, p = 0.6). The median length of stay was somewhat shorter in SSDH patients (10 [9-12] vs. 7.5 [6-10] days; p = 0.01). Overall survival was 100%. Conclusions: Trepanation is a widely-accepted technique for the treatment of CSDH. For acute subdural hematomas, there is no discussion regarding the need for a more aggressive approach (e.g., craniotomy or craniectomy). For SSDH, however, published evidence is not as conclusive; yet many centers treat such patients similarly to those with acute subdural hematomas, usually in the belief that trepanation and drainage would be insufficient. Based upon the results obtained in our series, we conclude that this technique is equally effective for the treatment of CSDH and SSDH, and recommend its routine use.

Twist-Drill or Burr Hole Craniostomy for Draining Chronic Subdural Hematomas: How to Choose It for Chronic Subdural Hematoma Drainage / 대한신경손상학회지

OBJECTIVE: Although twist-drill craniostomy (TDC) has a number of procedural advantages and an equivalent outcome compared to burr hole craniostomy (BHC) for the treatment of chronic subdural hematomas (CSDHs), the latter technique remains the preferred method. We analyzed symptomatic CSDHs in whom TDC at the pre-coronal suture entry point (PCSEP) was the primary method for hematoma drainage and BHC on the parietal was the secondary option. METHODS: CSDHs in 86 consecutive patients were included. TDC at the PCSEP, which is 1 cm anterior to coronal suture at the level of the superior temporal line, was the primary operational technique when the hematoma thickness was suitable, and BHC was performed via the parietal when TDC was unreasonable or failed. The clinical feasibility and outcomes of these approaches were analyzed. RESULTS: Of the 86 patients, 68 (79.1%) were treated by TDC, and 18 (20.9%) by BHC. All patients showed improvements in their symptoms after hematoma drainage. Neither morbidity nor mortality was associated with either technique, and there were no differences in drainage days between the groups. Ten patients had bilateral hematomas and were treated using TDC. Two patients were not sufficiently treated by TDC and, as a result, BHC was applied. Only six hematomas (7% of 86 hematomas) exhibited insufficient thickness on the computed tomography to perform TDC. CONCLUSION: When the hematoma was thick enough, a majority of the CSDHs were drained using TDC at the PCSEP as the first procedure, which was especially useful for bilateral hematomas and in elderly patients.

Herbicidas inibidores da accase em plantas de Cenchrus echinatus em estresse hídrico / Accase-Inhibitor herbicides in plants of Cenchrus echinatus in water stress

Este projeto objetivou relacionar a eficiência de controle de herbicidas inibidores da ACCase aplicados em pós-emergência em plantas de Cenchrus echinatus submetidas a diferentes teores de água no solo. Os experimentos foram conduzidos em casa de vegetação, com a aplicação de três diferentes herbicidas (fluazifop-p-butil, haloxyfop-methyl e sethoxydim + óleo mineral Assist). O delineamento experimental utilizado para cada herbicida foi inteiramente casualizado, com 4 repetições, constituído de um fatorial 3 x 4, sendo a combinação de três manejos hídricos (-0,03; -0,07 e -1,5 MPa) e quatro doses destes produtos (100, 50, 25 e 0% da dose recomendada). A aplicação dos herbicidas foi efetuada no estádio vegetativo de 2-3 perfilhos. Os manejos hídricos foram iniciados no estádio de desenvolvimento de duas folhas, repondo-se a água até o solo atingir o potencial de -0,01 MPa, quando este chegasse à tensão pré-determinada para cada manejo hídrico. As avaliações visuais de fitotoxicidade foram realizadas aos 7, 14, 21 e 28 dias após a aplicação e a matéria seca das plantas ao final destas. A eficiência de controle dos diferentes herbicidas foi influenciada pelos manejos hídricos sendo menor em plantas mantidas em potencial mínimo de água no solo de -1,5 MPa. Todos os herbicidas testados apresentaram controles insatisfatórios em aplicações tardias (plantas com 2-3 perfilhos).

This project aimed to relate the efficiency of control of ACCase inhibiting herbicides applied post-emergence in Cenchrus echinatus under different soil water contents. The experiments were conducted in a greenhouse, with the application of three different herbicides (fluazifop-p-butyl, haloxyfop-methyl and sethoxydim + oil Assist) and the experimental design for each herbicide was completely randomized design with four replications, consisting a 3 x 4 factorial, with the combination of water management strategies (-0.03, -0.07 and -1.5 MPa) and four doses of these products (100, 50, 25 and 0% of the recommended dose). Herbicide application was made at vegetative stage of 2-3 tillers. The water management strategies were initiated in the development stage of two leaves, replacing the water until the soil reaches the potential of -0.01 MPa, when it came to severe pre-determined for each water management. The physiological parameters evaluated were: photosynthetic rate, stomatal conductance, transpiration, leaf temperature and plant dry matter. The visual assessments of phytotoxicity were performed at 7, 14, 21 and 28 days after application. The efficiency of these herbicides was influenced by soil management and water lowest in plants grown in the minimal potential of water in the soil of -1.5 MPa. All the herbicides were unsatisfactory controls in applications late (2-3 tiller plants).

Spontaneous Resolution of a Large Chronic Subdural Hematoma Which Required Surgical Decompression

We report on a case of an 87-year-old woman who showed spontaneous resolution of a large chronic subdural hematoma which required surgical decompression. She had suffered from confused mentality and right side weakness of motor grade II for 10 days. The initial brain CT scan showed a 22 mm thick low density lesion located in the left fronto-temporo-parietal region with midline shift (12 mm) which required emergency decompression. However, because she and her family did not want surgery, she was followed up in the outpatient clinic. Five months later, follow up brain CT showed that the CSDH had disappeared and the patient became neurologically normal. The reasons for spontaneous resolution of CSDH remain unclear. We discuss the possible relation between mechanisms of physio-pathogenesis and spontaneous resolution of a large chronic subdural hematoma (CSH) in an elderly patient.

Role of a Burr Hole and Calvarial Bone Marrow-Derived Stem Cells in the Ischemic Rat Brain: A Possible Mechanism for the Efficacy of Multiple Burr Hole Surgery in Moyamoya Disease

OBJECTIVE: This study investigates the role of a burr hole and calvarial bone marrow-derived stem cells (BMSCs) in a transient ischemic brain injury model in the rat and postulates a possible mechanism for the efficacy of multiple cranial burr hole (MCBH) surgery in moyamoya disease (MMD). METHODS: Twenty Sprague-Dawley rats (250 g, male) were divided into four groups : normal control group (n=5), burr hole group (n=5), ischemia group (n=5), and ischemia+burr hole group (n=5). Focal ischemia was induced by the transient middle cerebral artery occlusion (MCAO). At one week after the ischemic injury, a 2 mm-sized cranial burr hole with small cortical incision was made on the ipsilateral (left) parietal area. Bromodeoxyuridine (BrdU, 50 mg/kg) was injected intraperitoneally, 2 times a day for 6 days after the burr hole trephination. At one week after the burr hole trephination, brains were harvested. Immunohistochemical stainings for BrdU, CD34, VEGF, and Doublecortin and Nestin were done. RESULTS: In the ischemia+burr hole group, BrdU (+), CD34 (+), and Doublecortin (+) cells were found in the cortical incision site below the burr hole. A number of cells with Nestin (+) or VEGF (+) were found in the cerebral parenchyma around the cortical incision site. In the other groups, BrdU (+), CD34 (+), Doublecortin (+), and Nestin (+) cells were not detected in the corresponding area. These findings suggest that BrdU (+) and CD34 (+) cells are bone marrow-derived stem cells, which may be derived from the calvarial bone marrow through the burr hole. The existence of CD34 (+) and VEGF (+) cells indicates increased angiogenesis, while the existence of Doublecortin (+), Nestin (+) cells indicates increased neurogenesis. CONCLUSION: Based on these findings, the BMSCs through burr holes seem to play an important role for the therapeutic effect of the MCBH surgery in MMD.

Comparison of the Indications and Treatment Results of Burr-Hole Drainage at the Maximal Thickness Area versus Twist-Drill Craniostomy at the Pre-Coronal Point for the Evacuation of Symptomatic Chronic Subdural Hematomas

OBJECTIVE: To analyze the clinical data and surgical results from symptomatic chronic subdural hematoma (CSDH) patients who underwent burr-hole drainage (BHD) at the maximal thickness area and twist-drill craniostomy (TDC) at the precoronal point. METHODS: We analyzed data from 65 symptomatic CSDH patients who underwent TDC at the pre-coronal point or BHD at the maximal thickness area. For TDC, we defined the pre-coronal point to be 1 cm anterior to the coronal suture at the level of the superior temporal line. TDC was performed in patients with CSDH that extended beyond the coronal suture, as confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed and analyzed. RESULTS: Of the 65 CSDH patients, 13/17 (76.4%) with BHD and 42/48 (87.5%) with TDC showed improved clinical performance and radiological findings after surgery. Catheter failure was seen in 1/48 (2.4%) cases of TDC. Five patients (29.4%) in the BHD group and four patients (8.33%) in the TDC group underwent reoperations due to remaining hematomas, and they improved with a second operation, BHD or TDC. CONCLUSION: Both BHD at the maximal thickness area and TDC at the pre-coronal point are safe and effective drainage methods for symptomatic CSDHs with reasonable indications.

The Efficacy of Titanium Burr Hole Cover for Reconstruction of Skull Defect after Burr Hole Trephination of Chronic Subdural Hematoma / 대한신경손상학회지

OBJECTIVE: Although burr hole trephination is a safe and effective surgical option to treat patients with chronic subdural hematoma (CSDH), it often results in a small but undesirable scalp depression from burr hole defect. This study is to evaluate the efficacy of titanium burr hole cover (BHC) for reconstruction of skull defects in these patients. METHODS: A hundred and ninety-six cases of burr hole trephinations for CSDHs between January 2009 and December 2013 were assigned into two groups; Gelfoam packing only (GPO) and reconstruction using titanium BHC group, according to the modalities of burr hole reconstructions. The incidences and depths of scalp depressions and incidences of postoperative complications such as infections or instrument failures were analyzed in both groups. We also conducted telephone surveys to evaluate the cosmetic and functional outcomes from patient's aspect. RESULTS: Significantly lower incidence (p<0.0001) and smaller mean depth (p<0.0001) of scalp depressions were observed in BHC than GPO group. No statistical differences were seen in postoperative infection rates (p=0.498) between the two groups. There were no instrument failures in BHC group. According to the telephone surveys, 73.9% of respondents with scalp depressions had cosmetic inferiority complexes and 62.3% experienced functional handicaps during activities of daily life. CONCLUSION: Titanium BHC is highly effective for reconstruction of skull defect after burr hole trephination of CSDH, and provides excellent cosmetic and functional outcomes without significant complications.

Recurrence of chronic subdural hematoma after surgery: An analysis of risk factors / 第二军医大学学报

Objective To determine the risk factors contributing to the recurrence of chronic subduralhematoma (CSDH). Methods The clinical data of 115 CSDH patients who received burr-hole irrigation in our hospital were retrospectively analyzed. Univariatie and multivarite analyses were performed to describe the relationships between CSDH recurrence and possible risk factors, including age, sex, Glasgrow Coma Scale (GCS) score, hepertension, diabetes mellitus (DM), with or without post-operative drainage, and observations of hematoma douche fluid. Results Recurrence of hematoma was found in 11 patients (9. 6%). Two variables were found to be independently associated with the recurrence of CSDH: diabetes mellitus and blood clot and floc in hematoma douche fluid (_P<0. 05). The other variables were not found to be significantly correlated with recurrence of CSDH. Conclusion Presence of blood clot and floc in hematoma douche fluid is a risk factor of CSDH recurrence, and history of DM is also closely related to post-operation CSDH recurrence.

A Comparative Analysis of Chronic Subdural Hematoma in Two Age Groups of Younger and Older than 75 Years / 대한신경손상학회지

OBJECTIVE: Chronic subdural hematoma (cSDH) is one of the most common types of intracranial hemorrhage. As the number of elderly people is increasing, the incidence of cSDH is growing. Therefore, we analyzed clinical manifestation of the cSDH. METHODS: The authors retrospectively reviewed the data of the 169 patients of cSDH who were 65 years or older and undergone burr-hole trephination and closed drainage in our hospital between January 2008 and December 2012. Patients were divided into two subgroups; group A: young than 75 years, group B: 75 years or older. We analyzed the differences of clinical aspects and surgical results in both groups. RESULTS: Proportion of male patients in group A (83.8%) was higher than in group B (58.4%) with statistical significance (p=0.003). Alteration of consciousness as an initial symptom was significantly more frequent in group A (17.5%) than in group B (4.4%)(p=0.006). Postoperatively, 164 of 169 patients (97%) were free from symptom within three days in both groups. Pneumonia followed the surgery in three patients (one in group A and two in group B). CONCLUSION: There were no difference in the rate of complications between group A and B. Therefore, burr-hole trephination and external drainage is safe and effective management in both groups.

Hematoma subdural crónico: análisis de 95 casos / Chronic subdural hematoma: analysis of 95 cases

El Hematoma Subdural crónico es una patología relativamente frecuente que predomina en adultos mayores. Es de inicio insidioso, su diagnóstico se basa en el cuadro clínico y estudios radiológicos como la tomografía computarizada (TAC), el manejo es predominante quirúrgico y su pronóstico es bueno. Se analiza en el presente estudio, una muestra de 95 expedientes clínicos de pacientes con dicho diagnóstico, síntomas iniciales, TAC pre y post diagnóstico, tratamiento y evolución...

Management Strategy and Outcome of Epidural Haematoma in Relation to Volume.

Epidural Haematoma (EDH) develops in 1-3% of all major head injuries and most common in the young. This crosssectional descriptive study was done to find out the management strategy and outcome of EDH in relation to clot volume. This study was performed from December'2006 to November'2007, by purposively selecting 77 cases of EDH from the Department of Neurosurgery, Dhaka Medical College Hospital (DMCH), Dhaka. The study showed that highest number of patients was in most active period of life, with male predominance (Male: Female =7.5:1). Causes of EDH were mostly due to assault (37.7%), followed by RTA (32.5%) and fall from height (29.8%). The study showed Patient having EDH Volume (EDHV) > 30ml will have 8.55 times more chance of having unfavorable outcome than patient having EDHV < 30 ml. Patient having EDHV > 30 ml will have 187.83 times more chance of requiring surgical intervention than those having EDHV <30 ml, which is statistically highly significant (p<0.001). Mortality rate of EDH can be reduced by giving early management either conservative or surgery. Delay in the management of EDH patients with poor level of consciousness and EDHV >30 ml has adverse effect on mortality and morbidity.