The curative effect of interventional embolization of middle meningeal artery for chronic subdural hematoma / 介入放射学杂志

Objective To evaluate the safety and efficacy of interventional embolization of middle meningeal artery(MMA)for the treatment of chronic subdural hematoma(CSDH).Methods The clinical data of 14 patients with CSDH(17 lesions in total),who were treated with simple embolization of MMA at the Yijishan Hospital of Wannan Medical College of China between July 2021 and July 2022,were retrospective analyzed.After superselective catheterization of MMA using a microcatheter was accomplished,Onyx-18 glue,a liquid embolization agent,was used to embolize the main trunk and the branches of MMA.Imaging follow-up was adopted at 30 days and 90 days after discharge from hospital to evaluate the absorption of hematoma,and the improvement of clinical symptoms was defined as the modified Rankin Scale score(mRS)being decreased≥1 point from the baseline value.Results Successful embolization of MMA was accomplished for all the 17 lesions in the 14 patients,and no procedure-related complications occurred.During the follow-up period,the clinical symptoms and signs were remarkably improved in all patients.The postoperative 90-day hematoma volume was reduced by more than 90%in 11 patients and by more than 40%in one patient,and in 2 patients the postoperative 30-day hematoma volume was reduced by more than 30%.Complete absorption of hematoma was seen in 11 patients,and partial absorption of hematoma was observed in 3 patients.Conclusion For the treatment of newly-developed or recurrent CSDH,interventional embolization of MMA is clinically safe and effective.(J Intervent Radiol,2024,32:12-16)

Role of thrombomodulin-thrombin-high mobility group box 1 pathway in chronic subdural hematoma / 中华神经医学杂志

Chronic subdural hematoma (CSDH) is a collection of blood, blood clots and their degradation products, encapsulated by membrane and located within dural border cell layer. Pathophysiological processes such as inflammatory responses within hematoma cavity, coagulation abnormalities, and abnormalities in neovascularization play significant roles in CSDH development. High mobility group box 1 (HMGB1) can mediate processes such as inflammation, angiogenesis, and hemostasis, while thrombomodulin (TM) can bind with HMGB1 and rely on thrombin to degrade HMGB1. Current research has confirmed that the expressions of TM, HMGB1, and their downstream related factors are abnormally increased in the hematoma fluid of CSDH; however, the role of TM-thrombin-HMGB1 pathway in CSDH development is not fully clear. This article reviews the role of TM-thrombin-HMGB1 pathway in CSDH development, aiming to provide some references for pathogenesis and new therapeutic targets of CSDH.

Rehabilitation with a Patient with Severe COVID-19 Who Presented with Acute Subdural Hematoma During Ventilator and Extracorporeal Membrane Ventilator Management：A case Report / The Japanese Journal of Rehabilitation Medicine

Introduction：Intracranial hemorrhage after severe coronavirus disease 2019 (COVID-19) is associated with increased mortality and unfavorable patient outcomes.Case：A man in his 60s with independent activities of daily living (ADL) was diagnosed with COVID-19, and placed on a ventilator on Day (D)-3 and VV-ECMO on D-5. On D-23, an emergency craniotomy was performed for a left acute subdural hematoma. The patient was weaned from VV-ECMO on D-27. On D-33, sitting was initiated. On D-36, the patient was weaned from the ventilator and began exercise therapy. The Glasgow coma score (GCS) was E2V1TM4. Basic movement as assessed by the Functional Status Score for ICU (FSS-ICU) and Barthel Index (BI), was 3 and 0 points, respectively. On D-40, wheelchair use commenced. He began standing with a long leg orthosis on D-50, and began walking on D-53.On D-67, the patient transferred to a convalescent hospital. His GCS was E4V4M6. Generalized cognitive decline and motor paralysis were noted. The right upper limb, hand, and lower limb were assessed as Brunnstrom recovery stage IV, V, and V, respectively. The patient's grip strength was 11.9 kg [right] and 18.3 kg [left]. His knee extensor strength was 0.13 kgf/kg [right] and 0.19 kgf/kg [left]. The FSS-ICU, walking speed, and BI were 21 points, 0.17 m/sec, and 40 points, respectively. The patient was discharged on D-240.Discussion：The Early Mobilization and Rehabilitation Expert Consensus reports that early mobilization and active exercise can improve ADL at discharge. Our patient was weaned from VV-ECMO as soon as possible and practiced standing and walking with a long leg orthosis, resulting in a better outcome.

Application of transfrontal neuroendoscopic surgery in the treatment of chronic subdural hematoma / 中国内镜杂志

Objective To evaluate the efficacy of transfrontal neuroendoscopic surgery in the treatment of chronic subdural hematoma.Methods Analysis of clinical data of 80 cases of chronic subdural hematoma.According to the surgical method,40 cases were divided into traditional external drainage of parietaltuber,40 cases were divided into transfrontal neuroendoscopic small bone window hematoma removal.The treatment efficiency,hematoma recurrence rate,operation time and intraoperative blood loss were compared between the two groups.Results Treatment efficiency of neuroendoscopic group was 95.0%,significantly higher than drainage group 75.0%,hematoma recurrence rate one month after surgery of neuroendoscopic group was 5.0%,significantly lower than that in drainage group 25.0%,operation time of neuroendoscopic group was(54.1±7.5)min,longer than that of drainage group(40.7±9.4)min,the differences were statistically significant(P<0.05).The intraoperative blood loss of neuroendoscopic group was(30.1±4.5)mL,compared with(27.1±6.4)mL in the drainage group,the difference was not statistically significant(P>0.05).Conclusion Transfrontal neuroendoscopic surgery can significantly improve the efficacy of chronic subdural hematoma,and hematoma recurrence rate is extremely low.It is worthy of clinical application.

Analysis of risk factors of massive cerebral infarction after craniocerebral injury in children with acute subdural hematoma / 中国神经精神疾病杂志

Objective To analyze and compare the clinical manifestations and imaging features of children with secondary massive cerebral infarction after acute subdural hematoma(ASDH),and to evaluate its potential risk factors in order to provide evidence for the prevention,early diagnosis and early treatment of secondary massive cerebral infarction after ASDH.Methods The clinical data of children with ASDH aged 4～12 years were retrospectively studied.All the children received routine operation.The diagnosis of post-traumatic secondary massive cerebral infarction(MCI)was based on low-density areas on CT images and clinical signs.Clinical and radiographic findings related to patient outcomes were reviewed and statistically compared.Univariate and multifactor Cox regression analysis was used to evaluate the MCI after operation to obtain the factors affecting MCI.Results A total of 67 cases were included in the study,with 32 cases included in the MCI group and 35 cases included in the non-MCI group.There were significant differences between MCI and non-MCI groups in age(t=2.016,P= 0.048),body mass(t=2.389,P=0.020),multiple injuries(χ2=11.121,P=0.001),GCS(Z=-4.730,P＜0.001),hematoma volume(χ2=12.890,P=0.002),MLS(χ2=12.261,P=0.002)and perioperative shock(χ2= 14.417,P＜0.001).GCS(OR=0.322,P=0.002),perioperative shock(OR=10.992,P=0.007),multiple injury(OR= 6.547,P=0.046)and MLS score(OR= 46.974,P=0.025)were major risk factors for MCI in children with ASDH.Conclusion Perioperative shock,multiple injuries,low GCS and MLS greater than 10mm are risk factors for MCI.The incidence of MCI is significantly increased in children with multiple risk factors.

Advances in the diagnosis and treatment of chronic subdural hematoma / 中国神经精神疾病杂志

Chronic subdural hematoma is one of the common central nervous system diseases in middle-aged and elderly people,and the incidence is increasing year by year.Drill and drain surgery is recognized as one of the effective ways to treat chronic subdural hematoma.However,there still exists a non-negligible recurrence after surgery.In addition,with the aging of the population,senior patients may have many underlying diseases.Therefore,the risk of surgery is high and some patients even have contraindications to surgery due to the long-term use of anticoagulant or antiplatelet drugs.In recent years,some progress has been made in the treatment of chronic subdural hematoma,such as oral atorvastatin can promote the absorption of chronic subdural hematoma,small-dose dexamethasone is used in the treatment of chronic subdural hematoma,neuroendoscopy-assisted treatment of segregated chronic subdural hematoma,and middle meningeal artery embolization surgery to reduce the recurrence of chronic subdural hematoma patients.Meanwhile,with the development of imaging,Computed Tomography(CT)and Magnetic Resonance Imaging(MRI)have made some progress in the diagnosis of chronic subdural hematoma.

Surgical Treatment of Chronic Subdural Hematoma under Local Anesthesia: Case Report and Literature Review / Tratamento cirúrgico de Hematoma Subdural Crônico sob anestesia local: Relato de caso e revisão de literatura

Introduction Optimal surgical treatment for chronic subdural hematoma (CSDH) in the elderly has been controversial. Whenever possible, a less invasive technique should be used to avoid complications. Case Report The patient was 82-years-old, with JPS; with diagnosis of liver cirrhosis due to alcohol abuse and history of recent myocardial infarction. He was admitted to the emergency room with temporal-spatial disorientation. The Glasgow coma scale (GCS) value on admission was 9. Left hemiparesis and osteotendinous hyperreflexia in the left side of the body. Noncontrast-enhanced cranial computed tomography (CT) showed right frontoparietal hypodense lesion with mass effect. Due to the clinical conditions of the patient, drainage of the hematoma was indicated through local anesthesia and sedation with midazolam. He was discharged after 8 days with improvement in his mental and neurological condition. Conclusion Drainage of CSDH using local anesthesia in an elderly person with severe comorbidity can reach excellent results.

Introdução O tratamento cirúrgico ideal para hematoma subdural crônico (HSDC) em idosos tem sido controverso. Sempre que possível uma técnica menos invasiva deve ser utilizada para evitar complicações. Relato do Caso Paciente de 82 anos portadora de JPS; com diagnóstico de cirrose hepática por abuso de álcool e história de infarto do miocárdio recente. Foi admitido no pronto-socorro com desorientação espaço-temporal. O valor da escala de coma de Glasgow (ECG) na admissão era 9. Hemiparesia esquerda e hiperreflexia osteotendinosa no lado esquerdo do corpo. A tomografia computadorizada (TC) de crânio sem contraste mostrou lesão frontoparietal hipodensa direita com efeito de massa. Devido às condições clínicas do paciente foi indicada drenagem do hematoma através de anestesia local e sedação com midazolam. Teve alta após 8 dias com melhora do quadro mental e neurológico. Conclusão A drenagem do HDC com anestesia local em idoso com comorbidade grave pode alcançar excelentes resultados.

Actualización epidemiológica: tasa de mortalidad por Hemorragia Subdural Traumática entre los años 2018-2022 en Chile / Epidemiological update: traumatic Subdural Hemorrhage mortality rate between 2018-2022 in Chile

Traumatic subdural hemorrhage (TSH) is an injury between the meningeal membranes, caused by traumas, especially traffic accidents. OBJECTIVE: To describe the mortality rate (MR) due to TSH in the period 2018-2022 in Chile. MATERIALS AND METHODS: Descriptive, observational, and cross-sectional study on MR due to TSH in the period 2018-2022 in Chile, according to gender, age group, regional distribution, place of death, and month of death. Anonymous and public databases were used. No ethics committee approval was required. RESULTS: The average MR due to TSH in Chile from 2018 to 2022 was 0.45/100,000 inhabitants, with a peak in 2018 (0.75) and a minimum in 2021 (0.31). Men had higher rates. Mortality increased with age, especially in those over 80 years. The Metropolitan Region accounted for 35.2% of TSH-related deaths. Hospitals and clinics were the main places of death (67.1%), with more deaths in March, July, and August. DISCUSSION: The MR due to TSH progressively decreased due to medical improvements. Men have higher rates, possibly due to risk factors or biological differences. The reduction in MR in hospitals is linked to changes in the severity and categorization of the place of death. The connection with traffic accidents is significant, especially between March and August, due to the return to academic activities and weather conditions. Additionally, TSH-related deaths are concentrated in densely populated regions with more traffic accidents.

Single versus double drainage in chronic subdural hematomas treated with burr-holes

Introduction: Chronic subdural hematoma is a frequent type of intracranial hemorrhage. Treatment for symptomatic cases is generally surgical. Burr-hole completion is the method of choice. Objective: To analyze the placement of a single versus double drain in patients with chronic subdural hematoma operated through burr-holes. Methods: An analytical correlational retrospective study was carried out in patients who underwent surgery for chronic subdural hematoma, between January 2018 and December 2020. The patients were divided into 2 groups based on the number of drains used: double or single. The variables were: age, morbidities, preoperative Glasgow Score, hematoma characteristics (laterality, internal architecture, maximum diameter, and midline shift), complications, and hospital stay. The probability value < 0.05 was considered statistically significant. Results: Of the 99 patients in the study, 39 were older than 75 years. The most frequent pattern was B with 25 cases (25,3 %). The diameter of the chronic subdural hematoma was more than 20 mm in 61 cases, and in 32 cases the displacement of the midline structures was greater than 10 mm. The average hospital stays 5,8 days. The most frequent complication was nosocomial pneumonia with eleven cases (11,11 %). The double drainage group showed fewer complications at 30 days. Conclusions: The placement of double subdural drainage in patients with chronic subdural hematoma operated through single or double burr-holes, and is related to fewer complications than those with single drainage.

Introducción: El hematoma subdural crónico es un tipo frecuente de hemorragia intracraneal. El tratamiento de los casos sintomáticos es generalmente quirúrgico. La terminación con agujeros de trépano es el método de elección. Objetivo: Analizar la colocación de drenaje simple versus doble en pacientes con hematoma subdural crónico operados mediante trepanación. Métodos: Se realizó un estudio retrospectivo correlacional analítico en pacientes operados de hematoma subdural crónico, entre enero de 2018 y diciembre de 2020. Los pacientes se dividieron en 2 grupos según el número de drenajes utilizados: doble o simple. Las variables fueron: edad, morbilidades, puntaje de Glasgow preoperatorio, características del hematoma (lateralidad, arquitectura interna, diámetro máximo y desviación de la línea media), complicaciones y estancia hospitalaria. El valor de probabilidad < 0,05 se consideró estadísticamente significativo. Resultados: De los 99 pacientes del estudio, 39 eran mayores de 75 años. El patrón más frecuente fue el B con 25 casos (25,3 %). El diámetro del hematoma subdural crónico fue mayor de 20 mm en 61 casos, y en 32 casos el desplazamiento de las estructuras de la línea media fue mayor de 10 mm. La estancia hospitalaria media fue de 5,8 días. La complicación más frecuente fue la neumonía nosocomial con once casos (11,11 %). El grupo de doble drenaje presentó menos complicaciones a los 30 días. Conclusiones: La colocación de drenaje subdural doble en pacientes con hematoma subdural crónico operados mediante trepanación simple o doble, se relaciona con menos complicaciones que aquellos con drenaje simple.

Polyvinyl alcohol particle embolization of middle meningeal artery in treating chronic subdural hematoma / 中华神经医学杂志

Objective:To investigate the efficacy, safety and surgical experience of middle meningeal artery embolization using polyvinyl alcohol particle in treating chronic subdural hematoma (CSDH).Methods:A total of 51 CSDH patients (25 accepted first treatment, 19 had invalid atorvastatin treatment, and 7 recurred after burr hole drainage) admitted to Department of Neurosurgery, First Affiliated Hospital of Army Medical University from May 2021 to August 2022 were enrolled. The characteristics of middle meningeal artery were evaluated by three-dimensional time-of-flight (3D TOF) MRA before embolization. With confirmation of no surgical contraindications, unilateral or bilateral embolization of the middle meningeal artery with polyvinyl alcohol particle was performed under local anesthesia. The hematoma recurrence rate and proportion of patients with reduction of maximum hematoma thickness>50% at 2 months after embolization were used as primary outcomes to evaluate the efficacy. Complications and embolization-related adverse events were recorded, and the experiences were retrospectively summarized.Results:For all 51 patients, the characteristics of the middle meningeal artery shown in the preoperative 3D TOF MRA were consistent with those in the intraoperative angiography; 16 patients with unilateral hematoma showed thickened bilateral middle meningeal arteries in preoperative 3D TOF MRA, bilateral blood supply was confirmed by intraoperative angiography and bilateral middle meningeal artery embolization was performed. Interventional embolization was successful in all 51 patients, including unilateral embolization in 19 and bilateral embolization in 32, with a total of 83 sides of embolizations. After embolization, hematoma was absorbed and symptoms improved in 48 patients, and hematoma recurrence was observed in 3 patients (5.9%), with an overall success rate of 94.1%. Excluding the 3 patients with hematoma recurrence, 39 patients completed the 2-month follow-up, and these patients had the maximum hematoma thickness reduction>50%. No mortality, complications or surgery-related adverse events were observed in them.Conclusion:Middle meningeal artery embolization with polyvinyl alcohol particle is safe and effective in treating CSDH; once bilateral middle meningeal artery blood supply is indicated by preoperative MRA in patients with unilateral hematoma, bilateral angiography and embolization should be considered during interventional treatment.

Liquefaction degrees of chronic subdural hematoma predicted by CT and MRI / 中华神经医学杂志

Objective:To explore the predictive values of preoperative CT and MRI features in intraoperative liquefaction degrees of hematoma in patients with chronic subdural hematoma (CSDH).Methods:Sixty-nine patients (83 sides) with CSDH, admitted to Department of Neurosurgery, Affiliated Hospital of Qingdao University were chosen; preoperative CT and/or MRI were performed in all patients. According to hematoma density in CT images, hematoma was divided into high-density, medium density and low-density hematoma; according to the proportion of hematoma part enjoying uniform signal in MRI images, hematoma was divided into heterogeneous signal hematoma and homogenized signal hematoma. The liquefaction degrees of hematoma in patients with different densities of hematoma, and heterogeneous signal hematoma and homogenized signal hematoma were compared, and the liquefaction degrees of hematoma in patients with special-shaped hematoma were summarized.Results:A total of 58 patients (69 sides) with CSDH completed preoperative CT examination; the intraoperative liquefaction degrees of hematoma in patients with different hematoma densities in CT images were significantly different ( P<0.05); the liquefaction degree of hematoma in patients with medium density hematoma was better than that of high-density hematoma and low-density hematoma (average rank: 40.71, 34.67 and 25.27). A total of 50 patients (63 sides) with CSDH completed preoperative MRI examination; the intraoperative liquefaction degrees of hematoma in patients with homogenized signal hematoma was better than that of heterogeneous signal hematoma, with significant difference (average rank: 46.53 and 17.00, P<0.05). The hematoma with soapy signs on preoperative CT or MRI images had blood clots mainly. Hematoma with fluid-fluid levels and fluid gradual changes had good liquefaction. Conclusion:Preoperative CT and(or) MRI images can effectively help to predict the intraoperative liquefaction degrees of hematoma in CSDH patients.

Caracterización epidemiológica: descripción de mortalidad para hemorragia subdural aguda no traumática en el período 2017-2021, en Chile / Epidemiological characterization: description of mortality for non-traumatic acute subdural hemorrhage in the 2017-2021 period, in Chile

Introducción: La hemorragia subdural aguda no traumática (HSDNT) es una patología relacionada a factores de riesgo cardiovascular (RCV). Por falta de estudios epidemiológicos nacionales, se plantea estudiar la tasa de mortalidad (TM) y defunciones por HSDNT entre los años 2017-2021 en Chile. Metodología: Estudio descriptivo, transversal, sobre defunciones por HSDNT entre los años 2017-2021 en Chile (N=878), según grupo etario, sexo y lugar de defunción, usando datos obtenidos del departamento de estadística e información en salud. Se utilizó estadística descriptiva y cálculo de TM. No requirió aprobación por comité de ética. Resultados: Se calculó una TM de 0,99/100.000 habitantes entre los años 2017-2021, siendo la mayor los años 2017-2019 y 2020 con TM de 1/100.000. El sexo masculino presentó TM de 1,27/100.000, el grupo etario mayor a 80 años presentó una TM de 19,28/100.000 habitantes. Según lugar de defunción, el año 2020 un 83% (148) de las defunciones fue en hospital o clínica. Discusión: La prevalencia del RCV hace relevante el estudio de mortalidad por HSDNT, donde la principal hipótesis de su mortalidad en Chile estaría basada en estos factores riesgo latentes. Según lugar de defunción, se podría suponer dadas mayores complicaciones en aquellos pacientes hospitalizados por HSDNT. Conclusión: Dada la nula existencia de datos sobre esta patología en Chile, se realizó una caracterización epidemiológica en conjunto a un análisis de defunciones según el lugar, aportando una perspectiva nacional de mortalidad sobre este cuadro en particular.

Introduction: Non-traumatic acute subdural hemorrhage (NTSDH) is related to cardiovascular risk factors (CVR). Due to lack of national epidemiological studies, it is proposed to study mortality rate (MR) and deaths from HSD between the years 2017-2021 in Chile. Methodology: Descriptive, observational, cross-sectional study on deaths due to SDH between the years 2017-2021 in Chile (N=878), in a population older than 15 years, according to age group, sex and place of death, using data obtained from Departamento de estadísticas e información en salud. Descriptive statistics and MR calculation were used. It did not require approval by an ethics committee. Results: A MR of 0.99/100,000 inhabitants was calculated between the years 2017-2021, the year being the highest in the years 2017-2019 and 2020 with MR of 1/100,000. Male sex presented a MR of 1.27/100,000, the age group over 80 years presented a MR of 19.28/100,000 inhabitants. By place of death, in 2020 there were 148 deaths in hospitals or clinics. Discussion: The prevalence of CVR makes the study of mortality from NTSDH relevant, where the hypothesis of its mortality in Chile would be based on these risk factors. Depending on the place of death, it could be assumed that there are greater complications in those patients hospitalized for NTSDH. Conclusion: Given the null existence of data on this pathology in Chile, an epidemiological characterization was carried out together with an analysis of deaths according to the place, providing a national perspective of mortality about this disease.

Surgical Management of the Armored Brain: Case Report of the Treatment of a Chronic Calcified Subdural Hematoma / Manejo cirúrgico do cérebro blindado: Relato de caso do tratamento de hematoma subdural crônico calcificado

Calcified chronic subdural hematomas (CCSDHs) are rare entities, whose yearly incidence ranges from 1.72 to 20.6 per every 100 thousand persons. Several different approaches to their management are reported in the literature, ranging from conservative treatment to craniotomy with full removal of the neomembranes. Currently, there are no guidelines or consensus that establish the best technique. We herein report a case of symptomatic CCSDH initially drained through a burr-hole craniotomy, with no resolution of the symptoms. Later, our patient underwent a craniotomy and partial membranectomy, which resulted in full symptomatic recovery.

Hematomas subdurais crônicos calcificados (HSDCCs) são entidades raras, cuja incidência anual varia de 1,72 a 20,6 casos a cada 100 mil pessoas. Várias abordagens diferentes para seu manejo são relatadas na literatura, desde o tratamento conservador até a craniotomia com remoção total das neomembranas. Atualmente não há diretrizes ou consensos que estabeleçam a melhor técnica. Nós relatamos um caso de HSDCC inicialmente drenado por meio de uma craniotomia por trepanação, sem resolução dos sintomas. Posteriormente, nosso paciente foi submetido a uma craniotomia e membranectomia parcial, que resultou em plena recuperação dos sintomas.

Parche de sangre cervical para tratamiento de síndrome de hipotensión/ hipovolumen de líquido cefalorraquídeo espontáneo. Reporte de un caso / Cervical blood patch for the treatment of spontaneous cerebrospinal fluid hypotension/hypovolume syndrome. A case report

Presentamos el tratamiento eficaz de una filtración espontánea de líquido cefalorraquídeo (LCR) asociada a un síndrome de hipoten-sión/hipovolumen de LCR a nivel cervical alto, caracterizado por delirio y hematomas subdurales secundarios, refractarios al drenaje quirúrgico, que se resolvió con dos parches de sangre epidurales cervicales consecutivos.

We present the case of a cerebrospinal fluid (CSF) hypotension/hypovolume syndrome due to a spontaneous CSF fistula at the upper cervical level characterized by loss of consciousness and bilateral subdural hematomas refractory to two drainage surgeries that resolved with two consecutive blood patches on the leak site.

Silent killer presenting as isolated oculomotor nerve palsy

Head trauma can result trivial to life threatening manifestations to a person. Subdural hemotomais characterised by accumulation of blood in subdural space, in most cases it is a serious condition and requires prompt diagnosis and treatment for the same to provide good outcome. Large collection, mid line shift, brain herniation associated with subdural hematoma is associated with increased morbidity and mortality. However, if the collection is minimal or is places like tentorium cerebelli may not have the typical presentation and if it抯 picked up using the subtle signs the devastating sequelae can be prevented. We report a 19 years old male with head trauma presenting with features of right-side isolated oculomotor nerve palsy who eventually found to have tentorial subdural hemotoma in imaging which has been intervened and complications were avoided.

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.

Recent advances in diagnosis and treatment of chronic subdural hematoma induced by leukemia / 中华神经医学杂志

Chronic subdural hematoma (CSDH) is a kind of common disease in neurosurgery. The traditional view is that tearing of the bridging vein is the main pathogenesis of traumatic brain injury. CSDH induced by leukemia is rarely reported, and its pathogenesis remains unclear. Diagnosis and treatment become difficult because of its combination with hematological system tumor, enjoying high mortality and disability rate. In view of close relationship between these 2 diseases, treatment should be simultaneous without priority. This paper reviews the pathogenesis, clinical manifestations, auxiliary examinations and treatments of CSDH caused by leukemia, and provides suggestions for clinical management of this kind of disease.

Clinical features of patients with syndrome of intracranial hypotension complicated by bilateral chronic subdural hematoma / 中华神经医学杂志

Objective:To explore the clinical features of patients with syndrome of intracranial hypotension (SIH) complicated by bilateral chronic subdural hematoma (CSDH).Methods:A case-control study was conducted; 16 patients with SIH complicated with bilateral CSDH (SIH group) and 32 patients with bilateral CSDH (non-SIH group) admitted to Department of Neurology and Neurosurgery, Shanghai Tenth People's Hospital Affiliated to Tongji University from January 2016 to October 2020 were selected. The differences of demographic characteristics, initial symptoms, medical history and CT image features between the two groups were compared.Results:(1) In 16 patients from the SIH group, 13 (81.3%) complained of typical postural headache symptoms, 3 (18.6%) showed fake subarachnoid hemorrhage on CT, 80.0% (12/15) showed dural diffuse enhancement on MRI, and 33.3% (5/15) showed signs of brain droop. Spinal MRI showed 27.3% patients (3/11) had signs of intracranial cerebrospinal fluid leakage. Of the 10 patients underwent bilateral trepanation and drainage, 6 experienced postoperative deterioration (4 received multiple additional surgeries including decompressive craniectomy, and 1 severe patient died in hospital after giving up treatment due to malignant tumor). (2) SIH group had significantly younger age, and significantly lower percentages of patients with limb weakness symptoms, hypertension, head trauma histories and increased hematoma pressure during trepanation and drainage, significantly lower age-adjusted comorbidities index, significantly decreased total and differential thickness of bilateral hematoma on CT, significantly shorter disease course, and statistically higher proportion of patients with postural headache and hematoma uniform density than non-SIH group ( P<0.05). Conclusion:According to age, initial symptoms and CT features, bilateral CSDH patients caused by SIH can be identified to a certain extent, and cranial and spinal MRI is recommended for definitive diagnosis of SIH.

A 44-year-old male Filipino with Spontaneous Acute Subdural Hematoma and Subarachnoid Hemorrhage caused by a Dural Arteriovenous Fistula of the Occipital Lobe: A case report

Introduction@#Spontaneous acute subdural hematoma (ASDH) is rare and comprises 2.6% of all ASDH. In one recent study, only 178 spontaneous ASDH were documented. However, only 1 case was attributed to dural arteriovenous fistula (dAVF). Vascular malformations cause less than 10% of subarachnoid hemorrhage (SAH). Spontaneous ASDH and SAH occurring together are extremely rare. Literature is scarce on cases with dAVF of the occipital lobe as a cause of simultaneous spontaneous ASDH and SAH. @*Objective@#This paper aims to present a case of a spontaneous acute subdural hematoma and subarachnoid hemorrhage caused by a dural arteriovenous fistula of the occipital lobe, along with its clinical presentation, diagnosis, and treatment. @*Case Summary@#A 44-year-old Filipino male with no history of trauma presented with severe headache, vomiting, and decreasing sensorium – CT scan revealed acute parenchymal bleed in the left occipital lobe with subarachnoid extension and subdural hematoma in the left fronto-parieto-temporal convexity along the tentorium cerebelli and posterior interhemispheric falx. Due to the location of the lesion seen on the CT scan and the gender distribution, Arteriovenous malformation (AVM) was initially considered, thus proceeded to computed tomography angiogram (CTA) to establish the diagnosis of vascular anomaly, however, revealed dAVF instead. Four-vessel angiogram was done to assess the tributaries of the dAVF and confirmed the diagnosis. Complete obliteration of dAVF of the occipital lobe was done with Onyx Embolization in one session. @*Conclusion@#This is the first case of Borden type II, Cognard type IIa+IIb dAVF, as reported in this institution. Although extremely rare as a cause of SAH and ASDH, dAVF should be considered a differential diagnosis in patients with no identifiable common cause of the new onset of severe headache and poor neurologic status.

Subdural hematoma following lumbar spine surgery

Abstract The occurrence of subdural hematomas following lumbar spine surgical procedures is a rare complication, but one with a high burden of morbidity and mortality, and despite an incidence rate of around 1%, it is a complication which must be considered in this group of patients. We present the case of a male patient, in the fourth decade of life, with a history of neurofibromatosis and spastic quadriparesis, who developed an altered state of consciousness following lumbar tumor resection, ending in a coma. A simple cranial CAT showed evidence of an acute right subdural hematoma which had to be drained via a craniotomy. He had an unsatisfactory postoperative course and died in the intensive care unit due to ARDS. The national literature has little information on this complication, therefore we believe that this case is an important contribution to the literature. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2094).