ABSTRACT
Cranioplasty complications after decompressive craniectomy (DC) in infants are not fully recognized. We aimed to devise and assess the efficacy of a hinge and floating DC (HFDC) technique for treating infantile acute subdural hematoma. Five infants, aged 2-20 months, were included. Intracranial pressure was controlled below 20 mmHg, no additional surgery was required, and there was no incidence of surgical site infection or bone graft resorption.
Subject(s)
Decompressive Craniectomy , Hematoma, Subdural, Acute , Craniotomy/adverse effects , Decompressive Craniectomy/adverse effects , Hematoma, Subdural, Acute/diagnostic imaging , Hematoma, Subdural, Acute/etiology , Hematoma, Subdural, Acute/surgery , Humans , Infant , Intracranial Pressure , Postoperative Complications , Skull , Surgical Wound InfectionABSTRACT
BACKGROUND: Chronic subdural hematoma (CSDH) often occurs in association with cerebrospinal fluid (CSF) hypovolemia. Many cases with CSDH due to CSF hypovolemia and treated by burr hole surgery have been reported to present with paradoxical deterioration. However, the mechanisms and pathology of deterioration after surgery for CSDH due to CSF hypovolemia remain obscure. CASE DESCRIPTION: We report herein a 62-year-old man with gait disturbance due to subdural fluid collection (SDFC) who underwent burr hole irrigation and additional craniotomy, in which postoperative deterioration resulted from rapidly progressing central herniation with a large amount of air accumulation. Epidural blood patch with saline infusion in the thoracic spine finally resolved central herniation. CONCLUSION: SDFC deteriorating after surgery has never been reported. SDFC has communication with CSF differing from mature CSDH composed of closed cavity surrounded by neomembrane. Under situations of CSF hypovolemia due to spinal dural tear, opening the cranium can prompt air replacement in the CSF space, which might represent a substantial risk for central herniation caused by a rapid loss of buoyancy force.
Subject(s)
Craniotomy , Encephalocele/etiology , Encephalocele/therapy , Hematoma, Subdural, Chronic/surgery , Intracranial Hypotension/surgery , Postoperative Complications/therapy , Air , Encephalocele/diagnostic imaging , Fatal Outcome , Hematoma, Subdural, Chronic/diagnostic imaging , Humans , Intracranial Hypotension/diagnostic imaging , Male , Middle Aged , Postoperative Complications/diagnostic imaging , Therapeutic IrrigationABSTRACT
A 78-year-old man was referred to our institution with a predominantly progressive numbness of both legs, and bladder dysfunction with urinary retention. He was diagnosed as the symptomatic arteriovenous fistula of the filum terminale (AVFFT). A trans-arterial embolization (TAE) of the arteriovenous shunt was planned for his symptomatic AVFFT. The long distance between the origin of the radiculo meningeal artery (Th8) and the site of the fistula (S1) resulted in the first TAE having a feeder occlusion. The length of accessible feeder in the first TAE was the longest (about 40 cm) as the past reports of the endovascular therapy. However, complete shunt occlusion was accomplished at a second session two weeks after the initial TAE because a more accessible feeder was developed by the initial feeder occlusion.
