Clinical feature analysis of subdural effusion/hematoma after shunt use of adjustable valves in children with hydrocephalus / 中华实用儿科临床杂志

Objective:To analyze the clinical data of children with hydrocephalus suffering from subdural effusion/hematoma after shunt(SEHS) with adjustable valves, and to provide reference for postoperative follow-up.Methods:A total of 102 children with hydrocephalus treated with adjustable valves in the Department of Neurosurgery, Wuhan Children′s Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from August 2017 to September 2021 were enrolled and studied retrospectively.There were 16 cases with SEHS, 11 of whom were male and 5 were female.The age ranged from 3 months to 13 years (median: 2.5 years). The age, clinical manifestations, the time of SEHS occurrence, treatment methods(pressure regulation only or combined with drilling and drainage), and prognosis of the patients were analyzed.The pressure adjustment treatment was to increase the by 10-20 mmH 2O (1 mmH 2O=0.009 8 kPa) each time and the patients were followed up 2-4 weeks after the adjustment.If SEHS didn′t improve according to the follow-up results, pressure regulation combined with drilling and drainage was recommended. Results:Of the 16 patients with SEHS, 3 cases were over 3 years old, and the other 13 cases were 3 years old or below.Eleven cases were treated by pressure regulation only, and 5 cases who were all aged ≤3 years received pressure regulation combined with drilling and drainage.Symptoms occurred in 2 patients, including vomiting in 1 case, and head and limb shaking in the other case.Fourteen cases were asymptomatic.The time from shunt operation to the occurrence of SEHS was ≤1 month in 5 cases, who were all cured by pressure regulation only.SEHS occurred in 5 cases >1-3 months after shunt surgery, and 2 cases of them were treated by pressure regulation combined with dri-lling and drainage.Three cases had SEHS>3-6 months after shunt surgery, and 1 case of them was treated by pressure regulation combined with drilling and drainage.SEHS occurred in 3 cases more than 6 months after shunt surgery, and 1 case of them was treated by pressure regulation combined with drilling and drainage.For the patients who received pressure regulation combined with drilling and drainage, the time from shunt operation to the occurrence of SEHS was 1 month and 21 days, 2 months and 7 days, 4.5 months, 7.5 months, and 25.0 months, respectively.The time from the occurrence of SEHS to the last reexamination with no SEHS detected was ≤1 month in 7 cases (all were cured by pressure regulation only); >1-3 months in 5 cases (3 cases were treated by pressure regulation combined with drilling and drainage); more than 3 months in 4 cases (2 cases were treated by pressure regulation combined with drilling and drainage). For the patients who received pressure regulation combined with drilling and drainage, the time from the occurrence of SEHS to the last reexamination with no SEHS detected was 1 month and 14 days, 2.0 months, 3.0 months, 7.0 months and 8.0 months, respectively.Except for 2 cases who experienced pressure regulating valve failure, all other cases were cured.Six cases were unilateral SEHS, and the SEHS volume was about 11 to 75 mL (median: 39.0 mL). Ten cases were bilateral SEHS, and the SEHS volume was about 23-380 mL (median: 158.2 mL). The 6 cases were all cured by pressure regulation, and 5 cases of them had SEHS at the shunt tube insertion side.Conclusions:SEHS in children with hydrocephalus is generally asymptomatic and rarely causes clinical symptoms.SEHS mostly occurs within 6 months after operation, especially within 3 months.SEHS found in 1 month after surgery can be cured by increasing the shunt valve pressure only.Therefore, SEHS can be cured by pressure regulation only by shortening follow-up and identifying SEHS early after shunt operation.This will also reduce the probability that patients require the drilling and drainage operation.

Analysis of Scores of SCL-90 of Patients with Traumatic Subdural Effusion / 法医学杂志

Objective To investigate the factors affecting changes of Symptom Check List-90 （SCL-90） of patients with traumatic subdural effusion. Methods One hundred and forty-two cases of patients with traumatic subdural effusion from the Center of Forensic Identification, Wannan Medical College collected from 2007-2018 were tested with SCL-90. The differences between SCL-90 results and the national norm and the influences of gender, age, education level, the number of effusion sites and location on SCL-90 results were analyzed. Results The differences between the scores of somatization, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia and psychosis factors and total mean scores in SCL-90 of traumatic subdural effusion and that of the national norm had statistical significance （P<0.05）. The differences in depression and hostility factor scores between males and females had statistical significance （P<0.05）. The differences in compulsion, anxiety and terror factor scores and total mean scores among different age groups had statistical significance （P<0.05）. The differences in hostility, paranoia and psychosis factors among patients with different degrees of education had statistical significance （P<0.05）. The differences in depression, anxiety, hostility and terror factor scores and total mean scores among single-site group, double-site group and multi-site group had statistical significance （P<0.05）. The differences in somatization, depression and anxiety factor scores and total mean scores between the right cerebral hemisphere group and the left cerebral hemisphere group and bilateral hemisphere group had statistical significance （P<0.05）. Conclusion Traumatic subdural effusion can cause certain psychological changes, which are related to the primary trauma of arachnoid tear as well as the number and location of effusion sites. Attention should be paid to the influence of the above factors during the assessment of psychological symptoms.

Risk factors of purulent meningitis complicated with subdural effusion in infants and young children / 中国实用儿科杂志

OBJECTIVE: To investigate the risk factors of purulent meningitis complicated with subdural effusion in infants and young children. METHODS: The clinical data of the infants and young children who were diagnosed with purulent meningitis in PICU of Shengjing Hospital of China Medical University from January 2014 to December 2017 were analyzed retrospectively.All of them were divided into 2 groups according to whether there was complication of subdural effusion. The statistical data were analyzed by SPSS 20.0 software. RESULTS: There were significant differences in hemoglobin,C reactive protein and protein in cerebrospinal fluid between control group and subdural effusion group(P<0.05). Logistic regression analysis showed that hemoglobin(OR=0.940,95%CI:0.899—0.998),C reactive protein(OR=1.015,95%CI:1.004—1.028)and protein in cerebrospinal fluid(OR=2.490,95%CI:1.151—6.315)were independent risk factors for purulent meningitis complicated with subdural effusion(P<0.05). CONCLUSION: Infants and young children diagnosed with purulent meningitis are with lower hemoglobin. Higher C reactive protein and higher protein in cerebrospinal fluid are likely to be complicated with subdural effusion.

Efficacy of decompressive craniectomy combined with ipsilateral external ventricular drainage for severe traumatic brain injury / 中华创伤杂志

Objective To investigate the efficacy of decompressive craniectomy (DC) combined with ipsilateral external ventricular drainage (iEVD) for severe traumatic brain injury (sTBI). Methods A retrospective case control study was performed on the clinical data of 54 sTBI patients admitted to the First People's Hospital of Taizhou from January 2015 to March 2018. There were 38 males and 18 females, aged 18-72 years [ (51. 8 ± 15. 4)years]. The Glasgow Coma Scale (GCS) of patients ranged from 3 to 8 points. Among 54 patients, 27 received DC treatment, including 18 males and nine females aged (50. 1 ± 2. 9)years (DC group);27 patients received DC combined with iEVD, including 18 males and nine females aged (53. 4 ± 3. 1) years (DC-iEVD group). Intracranial pressure after surgery and complications ( hydrocephalus and subdural hygroma) 2 weeks after surgery, andModified Rankin Scale (mRS) 3 months after surgery were compared between the two groups. Results All patients were followed up for 2.5-4 months [(3.0 ±0.8)months]. No significant difference was found in intracranial pressure at postoperative 12 hours and 24 hours between the two groups (P>0. 05). However, the intracranial pressure of DC-iEVD group were significantly lower than those of DC group at 36, 48, 60 and 72 hours after operation (P<0. 05). The hydrocephalus incidence 2 weeks after surgery of DC-iEVD group was 15％ (4/27), while that of DC group was 7％ (2/27)(P >0. 05). The subdural effusion incidence 2 weeks after surgery of DC-iEVD group was 19％ (5/27), while that of DC group was 44％ (12/27) (P<0. 05). According to mRS, patients with good outcome in DC-iEVD group accounted for 63％(17/27) while the ratio was 44％ (12/27) in DC group. The prognosis of DC-iEVD group was slightly better than that of DC group, but the difference was not statistically significant(P>0. 05). Conclusion For sTBI, combined use of DC and iEVD can better control intracranial pressure and reduce the occurrence of subdural effusion.

The Risk Factors of Subdural Hygroma after Decompressive Craniectomy / 대한신경손상학회지

OBJECTIVE: Subdural effusion, also known as subdural hygroma (SDG), is a secondary complication that can occur after decompressive craniectomy (DC). However, the pathogenesis of SDG is not fully understood. It is unclear whether SDG occurrence is related to preoperative patient status or surgical technique. The purpose of this study is to identify risk factors for SDG after DC. METHODS: Fifty-nine patients who underwent DC from January 2016 to December 2016 at the same institution were analyzed. We retrospectively reviewed the clinical and radiological features of the patients. We divided the patients into two groups based on the occurrence of SDG after DC. The risk factors for SDG were analyzed. RESULTS: The overall SDG rate after DC was 39% (23 patients). A statistically significant association was observed between preoperative diagnosis, e.g., subdural hemorrhage (SDH; odds ratio [OR], 4.99; 95% confidence interval [CI], 1.36–18.34) or subarachnoid hemorrhage (SAH; OR, 4.18; 95% CI, 1.07–16.32), and the occurrence of SDG after DC. Traumatic brain injury (OR, 4.91; 95% CI, 1.35–17.91) and preoperative cortical opening (OR, 4.77; 95% CI, 1.39–16.32) were important risk factors for SDG. Several surgical techniques did not show a statistically significant association with SDG. The occurrence of SDG after DC was related to the length of hospital stay (p=0.012), but not to prognosis. CONCLUSION: After DC, SDG is not related to patients' prognosis but to the length of hospital stay. Therefore, it is necessary to study the occurrence of postoperative SDG by confirming the presence of preoperative SDH, SAH, and cortical opening.

Clinical analysis of 72 cases of bacterial meningitis in infants under 6 months old / 中国综合临床

Objective To study the clinical characteristics and treatment outcome of infants with bacterial meningitis (BM) under 6 months.Methods Seventy-two cases of infants with BM under 6 months were retrospectively analyzed.Among them,the infants of age ranging from 29 days to 30 days were assigned into the 1 month age group,60 days to 179 days infants were assigned into the 2 to 5 months old group.Results The incidence of BM was more common in male (51 cases,70.8％) and infants with the age of 1 month (45 cases,62.5％).The clinical manifestations included fever (71 cases,98.6％),procalcitonin increase (55 cases,76.3％),respiratory tract infection (48 cases,66.6％),peripheral blood WBC count abnormal results (34 cases,47.3％),abnormal blood CRP (20 cases,27.8％) and nervous system abnormalities (18 cases,25％).Among the 1 month old group,12 infants had urinary tract infection (16.6％),and 6 had convulsions (8.3％).There were 4 cases (5.5％) with subdural effusion in the 2 ～ 5 months old group.Compared with the 2 ～ 5 months old group,the 1 month old group was more likely to be caused by urinary tract infection,more prone to seizures,the difference was statistically significant (x2 =3.996,3.927,P＜0.05).Compared with the 1 month old group,the 2 ～ 5 months old group was more prone to subdural effusion,and the peripheral blood white blood ceils was higher,the difference was statistically significant (x2 =7.059,4.295,P＜0.05).Conclusion There is no obvious clinical manifestation or laboratory examination for infants under 6 months old BM,so it is necessary to make early cerebrospinal fluid examination for early diagnosis and early treatment.

Risk assessment of chronic subdural hematoma after surgical clipping of intracranial aneurysms / 中国脑血管病杂志

Objective To compare the incidence of chronic subdural hematoma(CSDH) and its risk factors after surgical clipping unruptured intracranial aneurysms(UIA) and ruptured intracranial aneurysms (RIA). Methods From January 2006 to December 2015,410 consecutive patients with UIA and 464 patients with RIA treated with aneurysm clipping at the Department of Neurosurgery,Hanzhong Central Hospital were enrolled retrospectively. According to whether having postoperative CSDH or not(evaluating subdural effusion and its degree with head CT scan),the difference of the incidence of CSDH after aneurysm clipping in patients with UIA and RIA were compared,and logistic regression analysis was used to evaluate the risk factors for the occurrence of postoperative CSDH. Results (1) The incidence of CSDH after UIA clipping was higher than that of RIA(11.0% [45/410] vs. 3.0% [14/464]). There was significant difference (P<0.01). The rate of surgical treatment for CSDH because of the symptoms of nervous system injury in patients with UIA was higher than that in patients with RIA(35.6% [16/45] vs. 28.6% [4/14], P<0.05). (2) Multivariate logistic regression analysis showed that unruptured aneurysms (OR,2.59, 95% CI 2.19-3.06,P<0.01),subdural effusion ≥5 mm (OR,1.98,95% CI 1.94-2.03,P<0.01), and CT value≥40 HU (OR,2.87,95% CI 2.65-3.01,P<0.01) were the independent risk factors for postoperative CSDH in patients with intracranial aneurysm. Conclusions The incidence of CSDH was significantly higher than that of RIA after UIA clipping. UIA,subdural effusion ≥5 mm,and CT value ≥40 HU were the independent risk factors for CSDH of intracranial aneurysms.

The value of cerebrospinal fluid cytology and cell immunochemical staining in diagnosing meningeal carcinomatosis / 中国医师进修杂志

Objective To explore the diagnostic value of cytologic examination of cerebrospinal fluid (CSF) combined with cell immunochemical staining examination in the patients with meningeal carcinomatosis in the clinical track.Methods CSF was centrifuged and precipitated using the StatSpin Cytofuge 12 centrifuge. It was dyed by the May-Grunwald-Giemsa Staining (MGG) method and cell immunochemical staining (S-P method). Clinical data of 16 cases with the diagnosis of meningeal carcinomatosis were retrospectively analyzed. Results Sixteen patients diagnosed meningeal carcinomatosis prior to imaging findings in 11 of 16 patients were diagnosed meningeal carcinomatosis through the cerebrospinal fluid cytology combined with cell immunochemical staining prior to imaging findings. CSF cytology observed the cancer cell pleomorphism. Cell immunochemical staining examination clearly distinguished classification organic source of meningeal carcinomatosis. Conclusions CSF cytology combined with cell immunochemical staining examination is one of the important means in tracking intracranial metastatic tumor in clinic.

Symptomatic Relief of Idiopathic Infratentorial Superficial Siderosis with Maintaining Supine Position

Superficial siderosis results from the deposition of hemosiderin in subpial layers of the central nervous system following hemorrhage in subarachnoid spaces. Infratentorial superficial siderosis (ISS) presents with unique clinical features including progressive hearing loss, ataxia, and myelopathy, and the most common cause of idiopathic ISS is dural abnormality. Here we report a case of idiopathic ISS with radiological findings of spontaneous intracranial hypotension, whose clinical symptoms of ISS including cerebellar dysfunction improved after supine position was maintained for 2 months.

Risk factors for hydrocephalus after moderate to severe traumatic brain injury / 中华创伤杂志

Objective To investigate the risk factors of posttraumatic hydrocephalus (PTH) in patients with moderate to severe traumatic brain injury (TBI).Methods Aretrospective study was conducted for 183 patients with moderate to severe TBI (125 males,58 females;6-91 years of age,mean 48.23 years).According the presence of PTH,the patients were allocated into PTH group (n =34) and non-PTH group (n =149).Risk factors of PTh were assessed by univariate and logistic regression analysis,including gender,age,injury types,injury severity,intraventricular hemorrhage,subarachnoid hemorrhage,midline shift,subdural effusion,therapeutic strategies and skull defect.Association between the boundaries of skull defect and PTH was determined.Results Between-group differences were not significant regarding age,gender,injury types and intraventricular hemorrhage (P ＞ 0.05),but differed significantly in injury severity,subarachnoid hemorrhage,midline shift,subdural effusion,craniectomy and skull defect (P ＜ 0.05).Further Logistic regression analysis confirmed subarachnoid hemorrhage (OR =6.169),interhemispheric subdural effusion (OR =31.743),and unilateral (OR =17.602) and bilateral (OR =30.567) skull defects were risk factors of PTH.Of the patients with unilateral skull defect following decompressive craniectomy,the inferior limit ≤ 10 mm from the zygomatic arch also played a role in the development of PTH (OR =5.500,P ＜ 0.05).Conclusions Subarachnoid hemorrhage,interhemispheric subdural effusion and skull defect are risk factors of PTH.Unilateral skull defects with the inferior limit too close to the zygomatic arch can predispose to the development of PTH.

Efficacy of radiologic targeting epidural blood patch for spontaneous intracranial hypotension patients with multiple-level leakages of cerebrospinal fluid : an analysis of 36 cases / 中华麻醉学杂志

Thirty-six spontaneous intracranial hypotension patients with multiple-level leakages of cerebrospinal fluid were enrolled in the study.After 30 patients received targeted epidural blood intervention for 2 times and 6 patients received targeted epidural blood intervention for 3 times,the clinical symptoms were completely relieved.During injection of autologous blood,pain at the puncture site occurred in 24 cases,radiating pain in upper extremities in 5 cases,numbness in the upper extremity in 9 cases,radiating pain in lower extremities in 6 cases,numbness in lower extremities in 7 cases,headache in 4 cases,dizziness in 3 cases and transient bradycardia in 3 cases.Most of these symptoms were self-relieved after the end of injection or after slowing the injection rate,and some were self-relieved hours later.Neck stiffness was found in 2 cases and self-relived within a few hours or days after operation,and no severe nervous systemrelated complications were found.Recurrence happened in 2 cases at 3 months after the end of treatment,and the symptoms were self-relieved after receiving targeted epidural blood intervention for a second time.The patients were followed up for 15-36 months,and no serious nervous system-related complications were observed.Therefore,targeted epidural blood intervention is safe and effective when used to treat spontaneous intracranial hypotension caused by multiple-level leakages of cerebrospinal fluid in patients.

Biomaterial repair combined with continuous lumbar subarachnoid drainage for management of cerebrospinal fluid leakage and meningitis after spinal surgery / 中国组织工程研究

BACKGROUND:Traumatic or iatrogenic dural defects can cause persistent cerebrospinal fluid leakage, even progressing to life-threatening purulent meningitis. In patients with meningitis combined with cerebrospinal fluid leakage, most antibiotics are unable to enter the cerebrospinal fluid, as the cerebrospinal fluid is a good medium for bacteria and there is the presence of blood-brain barrier. So meningitis presents with acute onset, rapid development and infection difficult to control. OBJECTIVE:To evaluate the outcome of continuous lumbar subarachnoid drainage plus intrathecal administration of antibiotics for postoperative cerebrospinal fluid leakage combined with meningitis after biomaterial repair of dural defects. METHODS: A retrospective study was carried out to review the 12 cases of cerebrospinal fluid leakage combined with meningitis among 126 of 2 266 cases who developed cerebrospinal fluid leakage (5.56%) undergoing spinal surgery from June 2008 to June 2013. During the operation, dural defects were directly sutured or repaired with autologous fascial sheet. Al cases underwent thorough debridement and intravenous injection of sensitive antibiotics folowed by continuous lumbar drainage and intrathecal administration of sensitive antibiotics (usualy vancomycin), and then the incision was closed at stage I. RESULTS AND CONCLUSION:The cerebrospinal fluid leakage was found in the 12 cases at 24-72 hours after surgery, averagely 48 hours; the infection was found at 812 days days after surgery, averagely 9.5 days. Headache and fever were significantly relieved at the 2nd day of intrathecal administration of antibiotics, and intracranial infection disappeared at 7-14 days after continuous lumbar drainage. Biochemical test of the cerebrospinal fluid and routine examination were done thrice, and the results were al normal. No bacterial growth was found in bacterial culture test, and the drainage tube was removed. There was no intraspinal infection, intracranial hypotension headache and hernia caused by the drainage tube. These findings indicate that autologous fascia repair combined with continuous lumbar subarachnoid drainage plus intrathecal administration of antibiotics is an effective method in the treatment of cerebrospinal fluid leakage with meningitis.

Diagnostic value of auxiliary examination for childhood purulent meningitis complicated with subdural effusion / 中华实用儿科临床杂志

Objective To explore the clinical and peripheral blood characteristics of childhood purulent meningitis complicated with subdural effusion. Methods A retrospective cohort chart review was performed. A total of 162 consecutive cases of purulent meningitis were identified in Shenzhen Children′s Hospital from January 2009 to De-cember 2013,all of them were divided into 2 groups according to whether complicating with subdural effusion, and the clinical characteristics of 2 groups were analyzed. The clinical characteristics were analyzed. The statistical data were determined by SPSS 17. 0 software. Results Forty-nine cases(30. 25%)of them were complicated with subdural effu-sion;and 37 cases (75. 5%)of them suffered from the disease in the first 10 days after the onset of the meningitis,and the incidence was 48. 84% (42 cases) in infancy. Fever,lethargy,seizures and bulging fontanelle were its common clinical signs,and there were no significant differences in the incidence between subdural effusion group and the control group(non-subdural effusion group),the white blood cell (WBC) count did not increase markedly and C-reactive pro-tein(CRP) was high in the subdural effusion group on the admission day(Z=1. 74,2. 10,all P<0. 05),but no differ-ence in platelet( PLT) . The PLT was high in the whole meningitis cohort,the ratio of cases whose PLT was higher than 300×109/L reached 93. 75%,but no difference between the 2 groups. There were many factors of WBC on admission, including age, cerebrospinal fluid culture results and the application of antibiotics before admission, but CRP was only affected by antibiotics. Conclusions Subdural effusion is common in infancy,and most occurred in the first 10 days af-ter onset of the meningitis. On admission day the CRP,was high, while WBC did not increase too much. If CRP rises for the second time it might predict the occurrence of subdural effusion in bacterial meningitis. The increased PLT may be considered as clinical feature of infectious diseases. The clinical implication of inflammatory pathophysiology in men-ingitis needs further investigation.

One case report of group B streptococcus infection caused neonatal purulent meningitis and subdural effusion / 临床儿科杂志

Objective To discuss the early recognition and treatment of group B streptococcus (GBS) infection caused neonatal meningitis and subdural effusion. Method The onset, clinical manifestations, diagnosis and treatment process were retrospectively analyzed in one case of typical GBS infection caused neonatal meningitis and subdural effusion. Results The subject was late-onset GBS infection, with insidious onset, rapid progress, slow clinical recovery, and highly sensitive to vancomycin. During the treatment, the subject had relapses. The subdural effusion had been found. After extension of vancomycin treatment, the subject recovered. Conclusions The late onset GBS infection should be taken seriously in clinical, pay attention to the complications such as purulent meningitis, subdural effusion, hydrocephalus, and be early treated with adequate and effective antibiotics.

Clinical Characteristics of Pediatric Bacterial Meningitis Complicated with Subdural effusion / 대한소아신경학회지

PURPOSE: Authors aim to examine the clinical characteristics and relevant factors of the bacterial meningitis with the complication of subdural effusion. METHODS: We identified the 63 children with bacterial meningitis from 2006 to 2011. Thirteen children (group A) had a complication of subdural effusion during the treatment and 50 children (group B) did not. We reviewed their medical records retrospectively regarding demographic profiles, clinical features and laboratory findings. RESULTS: The mean age was younger in group A than in group B (4.9+/-10.1 vs 27.2+/-46.5 months, P=0.046). Of the initial symptoms, fever was the most frequent symptom, while seizures (30.8% vs 8.0%, P=0.028) and lethargy (38.5% vs 16.0%, P=0.070) were more common in group A. Since the antibiotics medication, the duration of vomiting (2.5+/-1.5 vs 1.1+/- 0.3 days, P=0.003) and irritability (2.5+/-1.5 vs 1.1+/-0.3 days, P=0.034) was longer in group A. Initial laboratory findings were significantly different between two groups with elevation of CRP (9.4+/-8.6 vs 4.1+/-6.6 mg/dL, P=0.010), CSF neutrophil ratio (71.2+/-16.4 vs 54.1+/-33.4%, P=0.041), and CSF protein (260.2+/-192.5 vs 119.9+/-148.5 mg/dL, P=0.003) in group A. Follow-up examination showed that CRP (9.3+/-10.4 vs 2.7+/-5.5 mg/dL, P=0.011), CSF cell count (670.6+/-1,014.0 vs 123.5+/-243.8 /mm3, P=0.006), and CSF protein (211.5+/-148.3 vs 82.1+/-85.8 mg/dL, P=0.002) were significantly higher in group A. CONCLUSION: Some significantly different results were shown in the comparison of initial symptoms and their durations and laboratory findings between the patients with subdural effusion following bacterial meningitis and those without subdural effusion.

"Use of gelatin sponge in ""sandwich"" method for prevention of cerebrospinal fluid leakage after repair of spinal dura mater" / 中华骨科杂志

Objective To investigate the therapeutic effect of the sandwich method (medical glue +gelatin sponge+medical glue) in the repair of spinal dura mater to prevent the cerebrospinal fluid leakage.Methods From February 2007 to June 2011,54 patients with spinal subdural tumors underwent excision of tumor in our hospital.According to manner of repairing spinal dura mater,all patients were classified into two groups:routine group and sandwich group.There were 16 males and 7 females with an average age of 45.2±7.2 years in the routine group,while 19 males and 12 females with an average age of 44.2±6.4 years in sandwich group.In routine group,the spinal dura mater was repaired through running locked suture.In sandwich group,the spinal dura mater was repaired through running locked suture,painting medical glue around the dural incision,covering with gelatin sponge,and painting medical glue on the surface and margin of gelatin sponge successively.Results Compared with the routine group,the total volume of postoperative drainage in sandwich group decreased significantly on the very day,the first day,the second day,and the third day,and the incidence of cerebrospinal fluid leakage decreased significantly.Before discharge,hydrops happened in 3 cases in the routine group,and got well through aspiration,continuous pressure by sandbag,and prone position.Three months after operation,5 cases from the routine group got deep hydrops under the incision and no treatment was applied to them.There was no obvious abnormality in the sandwich group.Conclusion The sandwich method can improve the repair effect of spinal dura mater injury,reduce the volume of postoperative drainage,and decrease the incidence of cerebrospinal fluid leakage

Prevention and treatment of cerebrospinal fluid leakage in anterior cervical surgery for severe ossification of posterior longitudinal ligament / 中华骨科杂志

Objective To investigate prevention and treatment of cerebrospinal fluid leakage (CSFL)in anterior cervical spine surgery for severe ossification of posterior longitudinal ligament (OPLL).Methods A retrospective analysis of 47 patients with severe cervical OPLL (thickness of the ossified mass ＞ 5 mm,spinal stenosis ＞50％),who had undergone anterior cervical surgery between January 2008 and May 2011,was conducted.Fifteen cases of dural defect were found intraoperatively,including 11 males and 4 females,aged from 40 to 68 years (average,55.6 years).Preoperative CT scans were earefully analyzed.During the operation,the ossified mass was excised or floated and the arachnoid was reserved in order to reduce dural damage.Dural defects were repaired by suturing or covering with muscle.After surgery,patients were confined to bed rest to allow for drainage or puncture.Results All 15 patients were followed up for 12 to 18months (average,14.8 months).After operation,10 patients recovered fully without CSFL.Five patients developed CSFL,including 4 cases of spinal dural mater injury that healed within 4-6 days with bed rest and pressure dressing,and 1 case of cerebrospinal fluid pseudocyst that disappeared within 3 weeks with repeat puncture and aspiration treatment.No cases required secondary operations or shunt placement.All cases exhibited good neurological improvement.Conclusion During anterior surgical treatment for severe cervical OPLL,CSFL can be effectively prevented through eareful analysis of preoperative CT images,meticulous operative technique,reasonable handling of the ossified mass and positive repair of dural damage.Moreover,postoperative bed rest and drainage are effective to treat CSFL.

Conduta na lesão dural intraoperatória em artrodese da coluna lombar / Conducta en lesión de duramadre intraoperatoria en artrodesis de la columna lumbar / Management of intraoperatory dural tear in lumbar spine arthrodesis

OBJETIVO: estudo retrospectivo de pacientes com lesão dural intraoperatória de cirurgia da coluna vertebral lombar, conduzido por meio de um protocolo independente da extensão da lesão, complicações associadas e resultados após seguimento mínimo de um ano. MÉTODOS: um total de 10 pacientes com durotomia acidental em cirurgias de descompressão e artrodese da coluna vertebral lombar, no período de Janeiro de 2007 a Janeiro de 2009, para tratamento de doença degenerativa, tiveram seus prontuários revisados, após terem sido tratados por meio de um protocolo embasado em reparo primário da lesão, drenagem subaracnoidea fechada, subfascial e subcutânea aspirativa realizados por cirurgião experiente, associado a repouso relativo com mobilidade precoce e terapia medicamentosa. Suas anotações e exames radiológicos foram verificados com seguimento pós-operatório e direcionados para identificação de sintomas sugestivos de complicações. RESULTADOS: todos os pacientes apresentaram boa evolução, sem ocorrência de fístula liquórica ou infecção pós-operatória; três deles apresentaram cefaleia pós-operatória de leve intensidade. Não houve necessidade de reoperação em nenhum desses pacientes. CONCLUSÃO: concluiu-se que a conduta adotada é segura e de bom resultado para os pacientes quando ocorre esse tipo de lesão, independentemente da extensão da mesma.

OBJECTIVE: a retrospective study of patients with spinal dural intraoperative lumbar spine surgery, conducted by means of a protocol regardless of the extent of the injury, associated complications and follow-up results after a minimum of one year. METHODS: a total of 10 patients with accidental durotomy in surgical decompression and arthrodesis of the lumbar spine during the period from January 2007 to January 2009 for treatment of degenerative disease had their records reviewed after being treated by a protocol based in primary repair of the lesion, closed subarachnoid drainage, subfascial and subcutaneous aspiration drainage performed by experienced surgeons, combined with relative rest with early mobilization and drug therapy. Their notes and imaging were verified with follow-up aimed to identify symptoms that could suggest complications. RESULTS: all patients had a good outcome, without occurrence of cerebrospinal fluid leaks or postoperative infection; three had postoperative headache of mild intensity. There was no need for reoperation in these patients. CONCLUSION: we concluded that the conduct adopted is safe and has a good outcome for patients when this type of injury occurs, regardless of its extent.

OBJETIVO: un estudio retrospectivo de pacientes con lesión de la duramadre intraoperatoria de cirugía en la columna lumbar, llevada a cabo por medio de un protocolo independiente de la extensión de la lesión, complicaciones asociadas y los resultados de seguimiento después de un mínimo de un año. MÉTODOS: 10 pacientes con durotomía accidental en la descompresión quirúrgica y artrodesis de la columna vertebral lumbar, en el período de enero de 2007 a enero de 2009, para el tratamiento de enfermedades degenerativas, tuvieron sus registros revisados después de tendieren sido tratados por un protocolo basado en la reparación primaria de la lesión, subaracnoidea drenaje cerrado, aspiración subfascial y subcutánea realizada por cirujanos con experiencia, combinada con el reposo relativo, con la movilización precoz y el tratamiento farmacológico. Sus notas y las imágenes fueron verificadas con el seguimiento postoperatorio y direccionadas para la identificación de síntomas sugestivos de complicaciones. RESULTADOS: todos los pacientes tuvieron buena evolución, sin registro de pérdidas de líquido cefalorraquídeo o infección postoperatoria, tres tuvieron cefalea en el postoperatorio de intensidad leve. No hubo necesidad de reintervención en esos pacientes. CONCLUSIÓN: la conducta adoptada es segura y con buen resultado para pacientes en los que este tipo de lesión se produce, independiente de la extensión de la misma.

The management of cerebrospinal fluid leakage after transsphenoidal surgical removal of pituitary adenomas / 中国医师进修杂志

Objective To evaluate the incidence and the causes of the intra-and postoperative cerebrospinal fluid(CSF)leakage during transsphenoidal surgical removal of pituitary adenomas,and discuss the sella closure methods.Method During the period from January 1998 to May 2008,118 patients underwent 134 transsphenoidal operations for pituitary adenomas.Two different methods to close the sella were used.The first one consisted packing the sella turcica and sphenoidal sinus with autologous fat and restoring the defect of sella turcica with autologous bone.In the second method,tht regenerated oxidized cellulose and collagen sponge with human fibrin were used to cover the seUa membrane defect and the dural defect,followed by packing the seHa with autologous fat.Proportions of each type of pituitary adenomas were analyzed.The frequency of the intra-and postoperative CSF leakage were evaluated in different type tumors and different operations.Data had been studied by statistical analysis.Results The incidence rate of intraoperative CSF leakage(26.5%,9/34)Was obviously increased in patients with growth homone adenoma compared with other type of adenoma(13.0%,13/100).Patients with invasive adenoma had an increased incidence rate of intraoperative CSF leakage(21.1%,8/38)compared with noninvasive adenoma(14.6%,14/96)(P＜0.05).When the descent of the sella turcica membrane Was visualized with tumor being totally removed,the incidence rate of intraoperative CSF leakage increased(18.7%,20/107)compared with when membrane descent was not seen with tumor remaining(7.4%,2/27)(P＜0.05).There were 3 cases postoperative CSF leakage happened in all 12 cases which adopted the first method. By the second method,there was no postoperative CSF leakage,and the number of postoperative complications was significantly smaller than the first method (10.0% and 33.3%,respectively). Conclusions The technique of covering the sella membrane and dural defects with oxidized cellulose and collagen sponge with human fibrin in the presence of intraoperative CSF leakage appears to be the most reliable,as no postoperative CSF leakage after applying this technique has been observed.

Evolution and treatment of traumatic subdural effusion / 中国基层医药

Objective To explore the evolution and treatment of traumatic subdural effusion(TSE).Methods The clinicsl materials of 66 patients with TSE were analyzed retrospectively.Results 53 patients were cured with comervative therapy,and other patients were evolved into chronic subdural hematoma(CSDH).8 patients with CSDH were cured with surgery and others with conservative therapy.Conclusion Patients with TSE don't need surgery,and then patients with clinical characteristics will be operated when TSE evolves into CSDH.