ABSTRACT
BACKGROUND: Chronic subdural haematoma (CSDH) is one of the most commonly treated condition in neurosurgery. It affects elderly populations who often have significant medical co-morbidities resulting in poor prognosis. The study aimed at identifying clinical factors influencing the survival following surgical management of CSDH. METHODS: Retrospective study included 267 cases that underwent surgery for CSDH and followed over 5-year period (2010-2015); data retrieved with reference to operation details, radiology reports and discharge. Using logistic and Cox regression analysis, the patient survival data was analysed with respect to patient demographics, type of surgery, co-morbidities, anticoagulation treatment, and discharge destination. RESULTS: The overall survival in the cohort was 37.0months (IQR: 20.0-60.0). The median age of the patients was 76years (IQR: 66-82) and the median length of hospital stay was 10days (range 1-126days; IQR: 6-17days). The recurrence rate was 6.37% (n=17). Fifty-three (19.85%) patients recorded deceased on the IPM database as of October 2016 and of those 11 died in hospital. Univariate Cox-regression analysis revealed increased age (HR: 1.80; 95%CI: 1.04-3.11), length of hospital stay (HR: 2.50; 95%CI: 1.41-4.41) and number of co-morbidities (HR: 2.19; 95%CI: 1.26-3.79) were associated with poor prognosis. Glasgow coma scale (GCS) at discharge was found to be significantly associated with survival whilst anticoagulation treatment did not. Multivariate analysis confirmed similar findings significant statistically. CONCLUSION: Age at admission, median length of hospital stay, number of co-morbidities, GCS at discharge and discharge destination have been found to influence survival significant statistically.
Subject(s)
Hematoma, Subdural, Chronic/surgery , Neurosurgical Procedures/adverse effects , Postoperative Complications/epidemiology , Aged , Aged, 80 and over , Female , Glasgow Coma Scale , Humans , Length of Stay , Male , Middle Aged , Neurosurgical Procedures/methods , Retrospective StudiesABSTRACT
BACKGROUND: Anterior cervical discectomy (ACD) is one of the most common spinal surgeries. Although rare, iatrogenic vertebral artery injuries (VAIs) are potentially life-threatening. Risk factors are anatomic, operative, and pathologic. We report a rare case of iatrogenic VAI during ACD and successful endovascular treatment with no long-term complications. We also review the literature on all VAIs associated with ACD and fusions. Risk factors and the safety and effectiveness of various management modalities are discussed. CASE DESCRIPTION: A 64-year-old patient sustained iatrogenic right VAI during ACD, followed by the delayed formation of a vertebral artery pseudoaneurysm and subsequent rehemorrhage. The patient recovered well with no long-term neurologic sequelae. This case is unusual because the pseudoaneurysm was not apparent on early computed tomography angiography. There is currently no consensus regarding the appropriate intraoperative management for iatrogenic VAIs. Described treatment modalities include direct repair, tamponade, and endovascular procedures. CONCLUSIONS: Delayed pseudoaneurysm formation after iatrogenic VAI can occur. Endovascular embolization can be a safe treatment alternative to surgical repair.
Subject(s)
Aneurysm, False/etiology , Cervical Vertebrae/surgery , Diskectomy/adverse effects , Postoperative Hemorrhage/etiology , Spinal Fusion/adverse effects , Vertebral Artery/injuries , Aneurysm, False/diagnostic imaging , Aneurysm, False/surgery , Cerebral Angiography , Computed Tomography Angiography , Endovascular Procedures , Humans , Iatrogenic Disease , Male , Middle Aged , Postoperative Hemorrhage/diagnostic imaging , Postoperative Hemorrhage/surgery , Time Factors , Vertebral Artery/diagnostic imaging , Vertebral Artery/surgeryABSTRACT
The authors report a case of temporal glioblastoma multiforme, who received post-operative radiotherapy. The patient presented to neurosurgery 8 months post-radiotherapy with CSF otorrhoea. This was shown to be from a defect of the right tegmen tympani secondary to radionecrosis of the petrous temporal bone. This was successfully repaired via craniotomy and repair of the middle cranial fossa floor. The authors have been unable to find previously published examples of isolated radio-necrosis of the temporal bone following radiotherapy for glioblastoma multiforme.
Subject(s)
Brain Neoplasms/radiotherapy , Cerebrospinal Fluid Otorrhea/etiology , Glioblastoma/radiotherapy , Radiation Injuries/pathology , Temporal Bone/pathology , Brain Neoplasms/surgery , Combined Modality Therapy , Glioblastoma/surgery , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Necrosis/pathology , Radiotherapy/adverse effectsABSTRACT
A 45-year-old lady presented with transient ischemic attack symptoms. Subsequent CT and DSA revealed multiple fusiform dilatations of cerebral vessels. A search for sources of emboli led to an atrial myxoma being found on echocardiogram. She made a good recovery after resection of the atrial myxoma. The aneurysms were managed conservatively. We discuss the association of multiple cerebral aneurysms with atrial myxoma.