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1.
Acta méd. peru ; 37(4): 511-517, oct-dic 2020. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1278175

ABSTRACT

RESUMEN El hematoma subdural crónico (HSDC) es una patología neuroquirúrgica frecuente, con una recurrencia de hasta el 30% de los casos. La embolización de la arteria meníngea media (AMM) es una estrategia de manejo adyuvante para disminuir la recidiva, especialmente en pacientes con factores de riesgo para recurrencia, y tiene una baja tasa de complicaciones. Presentamos el caso de un varón de 83 años con antecedente de anticoagulación, que es admitido en centro sanitario por presentar hemiparesia derecha, disartria y alteración de la marcha, con un tiempo de enfermedad de una semana. Se realizó trepanación y evacuación del HSDC sin complicaciones. Un mes después retornó por recidiva del HSDC, por lo que se realizó trepanación y evacuación adecuada del HSDC, seguida de embolización de la AMM ipsilateral. El control a los dos meses mostró ausencia de recidiva, con mejoría neurológica del paciente. Concluimos que la embolización de la AMM fue un tratamiento adyuvante eficaz para disminuir la recidiva del HSDC y podría estar indicada en pacientes con factores de riesgo asociados a la recurrencia.


ABSTRACT Chronic subdural hematoma (CSDH) is a frequent neurosurgical condition, which may develop recurrence in up to 30% of all cases. Embolization of the middle meningeal artery (MMA) is an adjuvant management strategy for reducing recurrence, especially in patients with risk factors, and it has a low complication rate. We present the case of an 83-year old male with history of anticoagulation, who was admitted in a healthcare facility because of right hemiparesis, dysarthria and gait impairment, and he had been sick for one week. A trepanation and CSDH evacuation were uneventfully performed. One month later, the patient was brought back because of CSDH recurrence, so another trepanation and adequate CSDH evacuation were performed, followed by embolization of the ipsilateral MMA. A control assessment after two months revealed absence of recurrence and neurological improvement. We conclude that MMA embolization was an efficacious adjuvant therapy aiming to reduce CSDH recurrence, and this procedure may be indicated in patients with risk factors for recurrence.

2.
Rev. Assoc. Med. Bras. (1992) ; 65(6): 834-838, June 2019. graf
Article in English | LILACS | ID: biblio-1012976

ABSTRACT

SUMMARY OBJECTIVES: To identify recurrence and its potential predisposing factors in a series of 595 patients with an initial diagnosis of Chronic Subdural Hematoma (CSDH) who underwent surgical treatment at a Reference Hospital of São Paulo. METHODS: A retrospective descriptive study, in which the medical records of all patients with a CSDH diagnosis submitted to surgical treatment from 2000 to 2014 were analyzed. RESULTS: The final study population consisted of 500 patients with a diagnosis of CSDH (95 patients with a diagnosis of Cystic Hygroma were excluded), of which 27 patients presented recurrence of the disease (5.4%). There were no statistically significant differences in relapses when cases were stratified by gender, laterality of the first episode or surgical procedure performed in the first episode (trepanning vs. craniotomy). It was possible to demonstrate an age-related protective factor, analyzed as a continuous variable, regarding the recurrence of the CSDH, with a lower rate of recurrence the higher the age. CONCLUSIONS: The results indicate that, among possible factors associated with recurrence, only age presented a protective factor with statistical significance. The fact that no significant difference between the patients submitted to trepanning or craniotomy was found favors the preferential use of burr-hole surgery as a procedure of choice due to its fast and less complex execution.


RESUMO OBJETIVOS: Identificar a taxa de recidiva e seus potenciais fatores predisponentes em série de 595 pacientes consecutivos com diagnóstico inicial de hematoma subdural crônico (HSDCr) submetidos a tratamento cirúrgico em hospital terciário de São Paulo nos últimos 14 anos. MÉTODOS: Estudo retrospectivo descritivo, no qual foram analisados os prontuários de todos os pacientes com diagnóstico de HSDCr submetidos a tratamento cirúrgico, no período de 2000 a 2014. RESULTADOS: A amostra final consistiu em 500 pacientes com diagnóstico de HSDCr — foram excluídos 95 pacientes com diagnóstico de higroma cístico —, dos quais 27 sujeitos apresentaram recidiva do quadro (5,4%). Não foram observadas diferenças estatisticamente significativas nas recidivas quando os casos foram estratificados por gênero, lateralidade do primeiro episódio ou procedimento cirúrgico executado no primeiro episódio (trepanação vs. craniotomia). Foi possível demonstrar um fator protetor relacionado à idade, analisado como variável contínua, no que diz respeito à recidiva do HSDCr, com menor taxa de recidiva com o avançar desta CONCLUSÕES: Os resultados indicam que, dentre os fatores possivelmente associados à recidiva, apenas a idade se apresentou como fator protetor com significância estatística. O fato de não ser demonstrada diferença significativa entre os pacientes submetidos a tratamentos cirúrgicos por trepanação ou por craniotomia favorece o uso preferencial da trepanação como procedimento de escolha, em virtude de apresentar execução rápida e menos complexa.


Subject(s)
Humans , Male , Female , Aged , Hematoma, Subdural, Chronic/etiology , Recurrence , Logistic Models , Sex Factors , Retrospective Studies , Risk Factors , Age Factors , Treatment Outcome , Craniotomy , Hematoma, Subdural, Chronic/surgery , Middle Aged
3.
Article in English | WPRIM | ID: wpr-765339

ABSTRACT

Treatment of chronic subdural hematoma (CSDH) is relatively straightforward, however, there is still some debate regarding the best strategy for treatment. The most practical recommendations of up to date were identified by a review of literature. The author reviewed the literature on CSDH management from the past to now to identify the best methods. Till 1970s, craniotomy was the most commonly used method. Burr hole (BH) became the most preferred method from 1980s. In 1977, twist drill (TD) craniostomy was introduced. Closed system drainage after a BH or a TD became the most frequently used surgical method. Although nonsurgical treatment is often successful, trephination has more advantages, such as rapid resolution of the symptoms and short period of hospitalization. Nonsurgical treatment is possible in asymptomatic patients with a small CSDH. For the symptomatic patients with CSDH, trephination is the treatment of choice, either by BH or TD. In gray zone between surgery and medical treatment, shared decision making can be an ideal approach. For the recurrent CSDHs, repeated trephination is still effective for patients with a low risk of recurrence. If the risk of recurrence is high, additional management would be helpful. For the refractory CSDHs, it is necessary to obliterate the subdural space.


Subject(s)
Craniocerebral Trauma , Craniotomy , Decision Making , Drainage , Hematoma, Subdural, Chronic , Hospitalization , Humans , Methods , Recurrence , Subdural Space , Trephining
4.
Chinese Journal of Trauma ; (12): 1051-1056, 2019.
Article in Chinese | WPRIM | ID: wpr-800786

ABSTRACT

Most patients with chronic subdural hematoma (CSDH) have a history of craniocerebral trauma. Avulsion of intracranial pontine vein is the main pathogenesis after craniocerebral injury. CSDH drilling and drainage is the most widely used surgical method, with low recurrence and mortality rate. However, the postoperative complication of subdural pyometra is extremely rare, which leads to high mortality and disability rate and thus representing a very challenging disease in trauma surgery. Old age, diabetes mellitus, drainage with foreign body, craniocerebral surgery, open wound, chronic systemic infectious diseases (sinusitis, otitis media, abdominal abscess, lung infection, urinary tract infection), tumor or immune deficiency diseases are all the high risk factors. This paper reviews the pathogenesis, pathogenic bacteria, clinical manifestations, auxiliary examination, treatment and prognosis of subdural empyema after CSDH drilling and drainage in recent years, and provides suggestions for clinical management.

5.
Journal of Chinese Physician ; (12): 1790-1793, 2019.
Article in Chinese | WPRIM | ID: wpr-800558

ABSTRACT

Objective@#To investigate the clinical characteristics and surgical results of patients with chronic subdural hematoma (CSDH) in different age groups.@*Methods@#150 CSDH patients admitted to our hospital from January 2014 to January 2019 were selected as the research objects, and their clinical data were reviewed and collected. According to different age , they were divided into three groups: the <55 year old group (n=46), the 55-70 year old group (n=62), and the >70 year old group (n=42). The imaging examination results and clinical manifestations of three groups of patients in different age groups were compared. Combined with patients' wishes and surgical indications, 150 patients were treated with traditional burr hole and drainage and modified operation. The results of different operation methods in three groups were compared.@*Results@#The incidence of headache/dizziness in the 55-70 year old group was higher than that in >70 year old group (P<0.05). The incidence of language disorder in the 55-70 year old group and >70 year old group was higher than that in <55 year old group , with statistically significant difference (P<0.05). The incidence of limb paralysis in the 55-70 year old group and the >70 year old group was higher than that in <55 years old group, with statistically significant difference (P<0.05). The incidence of mental disorders in the >70 year old group was higher than that in 55-70 year old group and <55 year old group, with statistically significant difference (P<0.05). The incidence of fecal incontinence in the >70 year old group was higher than that in 55-70 year old group and <55 years old group, with statistically significant difference (P<0.05). The imaging examination results of the three groups showed significant differences (P<0.05). According to the estimation of the amount of hematoma by the Dutian (DOTA) formula, the amount of hematoma in the group of >70 years old was significantly higher than that in the group of <55 years old and 55-70 years old, with statistically significant difference (P<0.05). Among the three groups, the proportion of patients with good prognosis after modified operation was higher than that of traditional operation, and the recurrence rate was lower than that of traditional operation, with statistically significant difference (P<0.05). The proportion of good prognosis and recurrence rate in group >70 years old were lower than those in the group of <55 years old and 55-70 years old (P<0.05).@*Conclusions@#CSDH patients of different ages have different characteristics in imaging examination results and clinical manifestations. Traditional burr hole drainage and modified operation can achieve certain results, but modified operation is more effective and can reduce the incidence of postoperative complications, which is worth popularizing.

6.
Journal of Chinese Physician ; (12): 1345-1348, 2019.
Article in Chinese | WPRIM | ID: wpr-798097

ABSTRACT

Objective@#To investigate the effects of single-hole and double-hole drilling and closed drainage on the expression of Hypoxia inducible factor-1α (HIF-1α), Claudin-5, transforming growth factor-β (TGF-β) and Smad2/3 in the epidermis of patients with chronic subdural hematoma.@*Methods@#100 patients with chronic subdural hematoma were randomly divided into single hole and double hole drainage group according to random number table. Immunohistochemical streptavidin-peroxidase (SP) was used to detect the expression of TGF- β protein, and Western blot was used to detect the expression of HIF-1α, Claudin-5 and Smad2/3 in the epihematoma of the two groups before and after operation.@*Results@#Compared with pre-operation, the expression of HIF-1α, TGF-β and Smad2/3 protein in adventitia of hematoma in both groups decreased after operation, especially in the double-hole group (P<0.05). The expression of Claudin-5 protein in adventitia of hematoma was significantly increased in both groups, especially in the double-hole group, with statistically significant difference (P<0.05).@*Conclusions@#Single-hole and double-hole drilling and sealing drainage is an effective method to treat chronic subdural hematoma. It can reduce the expression of HIF-1α, TGF-β and Smad2/3 protein in the epidermis of hematoma, and significantly increase the expression of Claudin-5, and the effect of double-hole drilling and sealing drainage is more significant.

7.
Journal of Chinese Physician ; (12): 1345-1348, 2019.
Article in Chinese | WPRIM | ID: wpr-791147

ABSTRACT

Objective To investigate the effects of single-hole and double-hole drilling and closed drainage on the expression of Hypoxia inducible factor-1α (HIF-1α),Claudin-5,transforming growth factor-β (TGF-β) and Smad2/3 in the epidermis of patients with chronic subdural hematoma.Methods 100 patients with chronic subdural hematoma were randomly divided into single hole and double hole drainage group according to random number table.Immunohistochemical streptavidin-peroxidase (SP) was used to detect the expression of TGF-β protein,and Western blot was used to detect the expression of HIF-1α,Claudin-5 and Smad2/3 in the epihematoma of the two groups before and after operation.Results Compared with pre-operation,the expression of HIF-1 α,TGF-β and Smad2/3 protein in adventitia of hematoma in both groups decreased after operation,especially in the double-hole group (P < 0.05).The expression of Claudin-5 protein in adventitia of hematoma was significantly increased in both groups,especially in the double-hole group,with statistically significant difference (P < 0.05).Conclusions Single-hole and double-hole drilling and sealing drainage is an effective method to treat chronic subdural hematoma.It can reduce the expression of HIF-1α,TGF-β and Smad2/3 protein in the epidermis of hematoma,and significantly increase the expression of Claudin-5,and the effect of double-hole drilling and sealing drainage is more significant.

8.
Article in English | WPRIM | ID: wpr-788768

ABSTRACT

Treatment of chronic subdural hematoma (CSDH) is relatively straightforward, however, there is still some debate regarding the best strategy for treatment. The most practical recommendations of up to date were identified by a review of literature. The author reviewed the literature on CSDH management from the past to now to identify the best methods. Till 1970s, craniotomy was the most commonly used method. Burr hole (BH) became the most preferred method from 1980s. In 1977, twist drill (TD) craniostomy was introduced. Closed system drainage after a BH or a TD became the most frequently used surgical method. Although nonsurgical treatment is often successful, trephination has more advantages, such as rapid resolution of the symptoms and short period of hospitalization. Nonsurgical treatment is possible in asymptomatic patients with a small CSDH. For the symptomatic patients with CSDH, trephination is the treatment of choice, either by BH or TD. In gray zone between surgery and medical treatment, shared decision making can be an ideal approach. For the recurrent CSDHs, repeated trephination is still effective for patients with a low risk of recurrence. If the risk of recurrence is high, additional management would be helpful. For the refractory CSDHs, it is necessary to obliterate the subdural space.


Subject(s)
Craniocerebral Trauma , Craniotomy , Decision Making , Drainage , Hematoma, Subdural, Chronic , Hospitalization , Humans , Methods , Recurrence , Subdural Space , Trephining
9.
Chinese Journal of Trauma ; (12): 1051-1056, 2019.
Article in Chinese | WPRIM | ID: wpr-824387

ABSTRACT

Most patients with chronic subdural hematoma (CSDH) have a history of craniocerebral trauma.Avulsion of intracranial pontine vein is the main pathogenesis after craniocerebral injury.CSDH drilling and drainage is the most widely used surgical method,with low recurrence and mortality rate.However,the postoperative complication of subdural pyometra is extremely rare,which leads to high mortality and disability rate and thus representing a very challenging disease in trauma surgery.Old age,diabetes mellitus,drainage with foreign body,craniocerebral surgery,open wound,chronic systemic infectious diseases (sinusitis,otitis media,abdominal abscess,lung infection,urinary tract infection),tumor or immune deficiency diseases are all the high risk factors.This paper reviews the pathogenesis,pathogenic bacteria,clinical manifestations,auxiliary examination,treatment and prognosis of subdural empyema after CSDH drilling and drainage in recent years,and provides suggestions for clinical management.

10.
Journal of Chinese Physician ; (12): 1790-1793, 2019.
Article in Chinese | WPRIM | ID: wpr-824302

ABSTRACT

Objective To investigate the clinical characteristics and surgical results of patients with chronic subdural hematoma (CSDH) in different age groups.Methods 150 CSDH patients admitted to our hospital from January 2014 to January 2019 were selected as the research objects,and their clinical data were reviewed and collected.According to different age,they were divided into three groups:the < 55 year old group (n =46),the 55-70 year old group (n =62),and the > 70 year old group (n =42).The imaging examination results and clinical manifestations of three groups of patients in different age groups were compared.Combined with patients'wishes and surgical indications,150 patients were treated with traditional burr hole and drainage and modified operation.The results of different operation methods in three groups were compared.Results The incidence of headache/dizziness in the 55-70 year old group was higher than that in > 70 year old group (P < 0.05).The incidence of language disorder in the 55-70 year old group and > 70 year old group was higher than that in < 55 year old group,with statistically significant difference (P <0.05).The incidence of limb paralysis in the 55-70 year old group and the >70 year old group was higher than that in < 55 years old group,with statistically significant difference (P < 0.05).The incidence of mental disorders in the > 70 year old group was higher than that in 55-70 year old group and < 55 year old group,with statistically significant difference (P < 0.05).The incidence of fecal incontinence in the > 70 year old group was higher than that in 55-70 year old group and < 55 years old group,with statistically significant difference (P < 0.05).The imaging examination results of the three groups showed significant differences (P < 0.05).According to the estimation of the amount of hematoma by the Dutian (DOTA) formula,the amount of hematoma in the group of >70 years old was significantly higher than that in the group of < 55 years old and 55-70 years old,with statistically significant difference (P <0.05).Among the three groups,the proportion of patients with good prognosis after modified operation was higher than that of traditional operation,and the recurrence rate was lower than that of traditional operation,with statistically significant difference (P < 0.05).The proportion of good prognosis and recurrence rate in group > 70 years old were lower than those in the group of < 55 years old and 55-70 years old (P <0.05).Conclusions CSDH patients of different ages have different characteristics in imaging examination results and clinical manifestations.Traditional burr hole drainage and modified operation can achieve certain results,but modified operation is more effective and can reduce the incidence of postoperative complications,which is worth popularizing.

11.
Article in English | WPRIM | ID: wpr-765219

ABSTRACT

OBJECTIVE: Diffusion-weighted magnetic resonance imaging (DW-MRI) has proven useful in the study of the natural history of ischemic stroke. However, the potential of DW-MRI for the evaluation of chronic subdural hematoma (CSDH) has not been established. In this study, we investigated DW-MRI findings of CSDH and evaluated the impact of the image findings on postoperative outcomes of CSDH. METHODS: We studied 131 CSDH patients who had undergone single burr hole drainage surgery. The images of the subdural hematomas on preoperative DW-MRI and computed tomography (CT) were divided into three groups based on their signal intensity and density: 1) homogeneous (iso or low) density on CT and homogeneous low signal intensity on DW-MRI; 2) homogeneous (iso or low) density on CT and mixed signal intensity on DW-MRI; and 3) heterogeneous density on CT and mixed signal intensity on DW-MRI. On the basis of postoperative CT, we also divided the patients into 3 groups of surgical outcomes according to residual hematoma and mass effect. RESULTS: Analysis showed statistically significant differences in surgical (A to B: p < 0.001, A to C: p < 0.001, B to C: p=0.129) and functional (A to B: p=0.039, A to C: p < 0.001, B to C: p=0.108) outcomes and treatment failure rates (A to B: p=0.037, A to C: p=0.03, B to C: p=1) between the study groups. In particular, group B and group C showed worse outcomes and higher treatment failure rates than group A. CONCLUSION: CSDH with homogeneous density on CT was characterized by signal intensity on DW-MRI. In CSDH patients, performing DW-MRI as well as CT helps to predict postoperative treatment failure or complications.


Subject(s)
Diffusion Magnetic Resonance Imaging , Drainage , Hematoma , Hematoma, Subdural , Hematoma, Subdural, Chronic , Humans , Magnetic Resonance Imaging , Natural History , Stroke , Treatment Failure
12.
Article in English | WPRIM | ID: wpr-717478

ABSTRACT

OBJECTIVE: The pathophysiology of chronic subdural hematoma (CSH) is not yet clear. Trauma alone is not sufficient to result in CSH in young individuals, while a trivial injury can result in CSH in older adults. Although the causality and apportionment of trauma are important issues in CSH, especially in terms of insurance, it is too obscure to solve all struggles. METHODS: There are three key factors for producing CSH. First, CSH necessitates a potential subdural reservoir. Other important precipitating factors are trauma and coagulopathy. However, these factors are not sufficient to cause CSH development. The trauma apportionment score (TAS) can be used to compare the relative importance of these three factors. Here, we applied the TAS to 239 consecutive cases of CSH. We retrospectively obtained the patients' history and laboratory results from their medical records. RESULTS: The TAS ranged from −5 to 5. The most common score was 0. If we defined the cause of CSH as being combined when the TAS was 0, then the cause was combined in 30 cases (12.6%). If we extended the criteria for a combined cause from 0 to −1 to 1, the cause was combined in 107 cases (44.8%). Regardless of the criteria used, traumatic CSHs were more common than were spontaneous CSHs. Spontaneous CSHs were more common in older than in younger patients (p < 0.01, Fisher's exact test). CONCLUSION: The TAS is a useful tool for differentiating the causality of CSH.


Subject(s)
Adult , Aging , Craniocerebral Trauma , Hematoma, Subdural, Chronic , Humans , Insurance , Intracranial Pressure , Medical Records , Precipitating Factors , Retrospective Studies
13.
Article in English | WPRIM | ID: wpr-717477

ABSTRACT

OBJECTIVE: Burr hole craniostomy and closed-system drainage (BCD) is a common surgical procedure in the field of neurosurgery. However, complications following BCD have seldom been reported. The purpose of this study was to report our experiences regarding complications following BCD for subdural lesions. METHODS: A retrospective study of all consecutive patients who underwent BCD for presumed subdural lesions at one institute since the opening of the hospital was performed. RESULTS: Of the 395 patients who underwent BCD for presumed subdural lesions, 117 experienced surgical or nonsurgical complications. Acute intracranial hemorrhagic complications developed in 14 patients (3.5%). Among these, 1 patient died and 5 patients had major morbidities. Malposition of the drainage catheter in the brain parenchyma occurred in 4 patients, and opposite-side surgery occurred in 2 patients. Newly developed seizures after BCD occurred in 8 patients (2.0%), five of whom developed the seizures in relation to new brain lesions. Eighty-eight patients (22.3%) suffered from nonsurgical complications after BCD. Pulmonary problems (7.3%) were the most common nonsurgical complications, followed by urinary problems (5.8%), psychologic problems (4.3%), and cognitive impairments (3.8%). CONCLUSION: The incidence of complications after BCD for subdural lesions is higher than previously believed. In particular, catastrophic complications such as acute intracranial hematomas and surgical or management errors occur at rates that cannot be ignored, possibly causing medico-legal problems. Great caution must be taken during surgery and the postoperative period, and these complications should be listed on the informed consent form before surgery.


Subject(s)
Brain , Catheters , Cognition Disorders , Consent Forms , Drainage , Hematoma , Hematoma, Subdural, Chronic , Humans , Incidence , Neurosurgery , Postoperative Complications , Postoperative Period , Retrospective Studies , Seizures , Trephining
14.
Journal of Neurocritical Care ; (2): 119-123, 2018.
Article in English | WPRIM | ID: wpr-765909

ABSTRACT

BACKGROUND: Since the first report of a rapidly resolved subdural hemorrhage (SDH) in 1986, few additional case reports have been presented in the literature. CASE REPORT: An 82-year-old female patient presented with a SDH over the left convexity. The SDH was removed via catheter drainage through a burr hole trephination. Post-operative computed tomography (CT) following 300 mL drainage from the chronic SDH demonstrated a newly developed SDH along the right convexity. A follow-up CT performed 2 hours later revealed an unexpected significant resolution of the acute SDH. CONCLUSION: The spontaneous resolution of acute SDH is believed to result from redistribution by washout of the hematoma by cerebrospinal fluid dilution. However, its exact pathophysiology is not well understood. When surgical evacuation is considered in acute SDH, conservative management should also be considered because spontaneous resolution of hemorrhage remains a possibility.


Subject(s)
Aged, 80 and over , Catheters , Cerebrospinal Fluid , Drainage , Female , Follow-Up Studies , Hematoma , Hematoma, Subdural , Hematoma, Subdural, Chronic , Hemorrhage , Humans , Trephining
15.
Journal of Chinese Physician ; (12): 1355-1358, 2018.
Article in Chinese | WPRIM | ID: wpr-706000

ABSTRACT

Objective To analyze the incidence and predictors of chronic subdural hematoma (CSDH) after surgical clipping between unruptured intracranial aneurysms (UIAs) and ruptured intracranial aneurysms (RIAs).Methods A retrospective cohort study was adopted to collect 486 cases of aneurysm patients (102 cases of UIAs patients and 384 RIAs patients) closed by aneurysm surgery who were admitted to the department of neurosurgery of The Fifth People's Hospital of Chengdu from October 2009 to December 2017.The clinical data,preoperative and postoperative imaging data and postoperative follow-up results were collected.The incidence of CSDH after operation in UIAs patients and RIAs patients was compared.The risk factors of CSDH after UIAs and RIAs patients were analyzed by multivariate Logistic regression model.Results The incidence of CSDH in UIAs and RIAs patients (10.78% vs 3.13%,x2 =10.487,P =0.001) and the reoperation rate after CSDH (3.92% vs 0.78%;x2 =5.599,P =0.018) were all statistically different,all of which showed that the patients with UIAs were higher than those of the patients with RIAs.Brain atrophy of grade 3-4 (OR =1.978,95% CI:1.939-2.030,P < 0.001),subdural effusion CT value ≥40 (OR =3.394,95% CI:2.908-3.867,P < 0.001) and subdural effusion (OR =2.872,95% CI:2.648-3.019,P <0.001 grade) of Ⅰ B are independent risk factors of CSDH in patients with UIAs after aneurysm clipping (P <0.05).Subdural effusion CT value ≥ 40 (OR =3.442,95% CI:2.918-3.8769,P < 0.001) and grade Ⅰ B subdural effusion (OR =2.329,95% CI:2.011-2.564,P < 0.001) are independent risk factors for CSDH in patients with RIAs after aneurysm clipping (P <0.05).Conclusions The incidence of CSDH after aneurysm clipping in UIAs patients was significantly higher than that of RIAs patients.The risk factors for CSDH in the two groups were not the same.

16.
International Journal of Surgery ; (12): 117-121, 2018.
Article in Chinese | WPRIM | ID: wpr-693206

ABSTRACT

Objective To evaluate the clinical effect of chronic subdual hematoma between surgical procedure twist drill craniostomy with injecting urokinase into hematoma space and only with twist drill craniostomy.Methods Two hundred and twenty-five patients with chronic subdual hematoma patients who were admitted in the Affiliated Hospital of Yangzhou University from January 2011 to April 2017 were retrospectively analyzed.They were divided into two groups according to the different surgical methods,group A for twist drill craniostomy with injecting urokinase into hematoma space (n =116),group B only for twist drill craniostomy (n =109).Then the postoperative drainage volume and residual hematoma was analyzed by repeated measures,while radiographic grading system and recurrence rates after operation were compared between groups with statistical analysis which was done by ANOVA analysis or non-parametric rank sum test.Results The drainage volume 48 hours after surgery was(52.41 ± 7.86) ml in group A,(28.42 ± 4.46) ml in group B as well.The residual volumes which were calculated at 1 month,3 months after surgery was (23.35 ±4.18) ml and (15.31 ±6.15) ml in group A,comparing the volumes of (46.07 ± 5.96) ml and (25.60 ± 5.03) ml in group B.The radiographic grading system was evaluated by grade 1-4.There were 75(64.7%) cases in grade 1,32(27.6%) cases in grade 2,8(6.9%) cases in grade 3,1 (0.9%) cases in grade 4 of group A,as well as 42(38.5%) cases in grade 1,55(50.5%) cases in grade 2,11 (10.1%) cases in grade 3,1 (0.9%) cases in grade 4 of group B.The rate of recurrence for chronic subdural hematoma was 6.0% in group A,while it was 15.6% in group B.These data all had significant statistical difference between the two groups (P < 0.05).Conclusion Twist drill craniostomy might be a safe,effective and mini-massive method for treating chronic subdual hematoma,while injecting urokinase into the hematoma space could significantly reduce the rate of recurrence and decrease the volume of hematoma.

17.
Article in English | WPRIM | ID: wpr-788649

ABSTRACT

OBJECTIVE: Diffusion-weighted magnetic resonance imaging (DW-MRI) has proven useful in the study of the natural history of ischemic stroke. However, the potential of DW-MRI for the evaluation of chronic subdural hematoma (CSDH) has not been established. In this study, we investigated DW-MRI findings of CSDH and evaluated the impact of the image findings on postoperative outcomes of CSDH.METHODS: We studied 131 CSDH patients who had undergone single burr hole drainage surgery. The images of the subdural hematomas on preoperative DW-MRI and computed tomography (CT) were divided into three groups based on their signal intensity and density: 1) homogeneous (iso or low) density on CT and homogeneous low signal intensity on DW-MRI; 2) homogeneous (iso or low) density on CT and mixed signal intensity on DW-MRI; and 3) heterogeneous density on CT and mixed signal intensity on DW-MRI. On the basis of postoperative CT, we also divided the patients into 3 groups of surgical outcomes according to residual hematoma and mass effect.RESULTS: Analysis showed statistically significant differences in surgical (A to B: p < 0.001, A to C: p < 0.001, B to C: p=0.129) and functional (A to B: p=0.039, A to C: p < 0.001, B to C: p=0.108) outcomes and treatment failure rates (A to B: p=0.037, A to C: p=0.03, B to C: p=1) between the study groups. In particular, group B and group C showed worse outcomes and higher treatment failure rates than group A.CONCLUSION: CSDH with homogeneous density on CT was characterized by signal intensity on DW-MRI. In CSDH patients, performing DW-MRI as well as CT helps to predict postoperative treatment failure or complications.


Subject(s)
Diffusion Magnetic Resonance Imaging , Drainage , Hematoma , Hematoma, Subdural , Hematoma, Subdural, Chronic , Humans , Magnetic Resonance Imaging , Natural History , Stroke , Treatment Failure
18.
Tianjin Medical Journal ; (12): 758-760, 2018.
Article in English | WPRIM | ID: wpr-810873

ABSTRACT

@#This article report a case of patient with chronic subdural hematoma. After receiving a surgery, the patient presented mental symptoms such as abnormal behaviors and personality changes. The patient was diagnosed as hepatic encephalopathy and secondary epilepsy according to his medical history, laboratory tests, head CT / MRI and electroencephalogram. The secondary epilepsy was diagnosed by convulsion. After receiving corresponding therapy, these symptom disappeared.

19.
Article in Chinese | WPRIM | ID: wpr-509180

ABSTRACT

Objective To explore the effect of atorvastatin on postoperative complications after the burr hole drainage of chronic subdural hematoma (CSDH). Methods The clinical data of 172 CSDH patients who had underwent the burr hole drainage were retrospectively analyzed. Among them 82 patients were given atorvastatin (atorvastatin group), and 90 patients were not given atorvastatin (control group). The postoperative complications were compared between 2 groups. Results All patients were followed up for 6 months. The total incidence of postoperative complications in control group was significantly higher than that in atorvastatin group:47.78%(43/90) vs. 31.71%(26/82), and the recurrent rate of subdural hematoma and incidence of subdural effusion in control group were significantly higher than those in atorvastatin group: 22.22% (20/90) vs. 8.54% (7/82) and 28.89% (26/90) vs. 12.20%(10/82). There were statistical differences (P0.05). Conclusions Atorvastatin can improve the prognosis of CSDH patients, especially in reducing the incidence of recurrent subdural hematoms and subdural effusion.

20.
Article in English | WPRIM | ID: wpr-26697

ABSTRACT

OBJECTIVE: To determine whether baseline cerebral atrophy can predict the rate of future chronic subdural hematoma (CSDH) after head trauma and compare indirect markers of brain atrophy with volumetric analysis of computed tomography (CT). METHODS: Single institution case-control study involving 1,476 patients who visited our hospital after head trauma from January 2009 to December 2014. Forty-one patients with delayed CSDH were identified and age, gender matched 41 patients were selected as control group. Both volumetric analyze on CT and Evans index, frontal horn index, bicaudate ratio, sylvian fissure ratio and cortical atrophy scale of 82 patients were estimated by different raters and relationship of those factors with CSDH was analyzed. RESULTS: Every indirect indices except cortical atrophy scale were not enough to give a good estimate of CSDH. Brain atrophy and cortical atrophy scale were predisposing factors of CSDH on multivariate analysis with statistical significance. CONCLUSION: Brain atrophy was a potential prognostic factor of CSDH after trauma. In practice, patients with a value of cortical atrophy scale over moderate grade needed more attention for CSDH.


Subject(s)
Animals , Atrophy , Brain , Case-Control Studies , Causality , Craniocerebral Trauma , Evaluation Studies as Topic , Hematoma, Subdural, Chronic , Horns , Humans , Multivariate Analysis
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