Independent Risk Factors for Postoperative Seizures in Chronic Subdural Hematoma Identified by Multiple Logistic Regression Analysis.

BACKGROUND: Postoperative seizures are potential complications of chronic subdural hematoma (cSDH). Knowledge of risk factors may help to identify patients that may benefit from antiepileptic prophylaxis. METHODS: A total of 101 patients (mean age, 70.1 ± 32.1 years) with surgical evacuation of cSDH were enrolled. We retrospectively collected patient characteristics, hematoma specifics, and procedural aspects and evaluated their impact on postoperative seizures within a 14-day follow-up period by means of bivariate logistic regression analysis. RESULTS: Postoperative seizures occurred in 14 patients (13.9%). At discharge, the mean Markwalder grading scale score was 1.1 ± 1.1 and 0.5 ± 0.8 in patients with and without seizures, respectively (P = 0.04). In the univariate analysis, preoperative midline shift (8.3 vs. 4.5 mm, P = 0.045), open craniotomy (85.7% vs. 55.2%, P = 0.031), and membranectomy (57.1% vs. 20.7%, P = 0.004) were significantly associated with postoperative seizures, respectively. In the multivariate analysis, preoperative midline shift (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.26; P = 0.029) and membranectomy (OR, 3.9; 95% CI, 1.0-15.0; P = 0.048) remained as independent risk factors for seizures. CONCLUSIONS: Perioperative antiepileptic prophylaxis may be recommended in patients with preoperative midline shift. Membranectomy may not be routinely applied during surgery.

Application of Intraoperative FLOW 800 Indocyanine Green Videoangiography Color-Coded Maps for Microsurgical Clipping of Intracranial Aneurysms.

OBJECTIVE: Indocyanine green (ICG) videoangiography (VAG) is an established method for assessment of cerebral blood flow during microsurgical clipping of intracranial aneurysms. FLOW 800 is a surgical microscope-integrated software program that shows the cerebral blood flow in color-coded maps, thus providing semi-quantitative and real-time analysis of ICG data. We aimed to establish reference values for FLOW 800 parameters before and after microsurgical clipping of intracranial aneurysms and to evaluate the potential of FLOW 800 to guide intraoperative decisions. METHODS: We retrospectively reviewed 54 patients (mean age, 53.6 ± 11.6 years) who underwent microsurgical clipping for 60 aneurysms and intraoperative evaluation of ICG fluorescence dynamics using FLOW 800 color-coded maps. FLOW 800 data were correlated with patient characteristics, clinical outcomes, and intraoperative decision making. RESULTS: There were no significant differences in FLOW 800 data between ruptured and unruptured aneurysms (P > 0.05). Likewise, the hemodynamic parameters were not significantly different before and after definite clip placement (P > 0.05). However, in 2 cases, analysis of transit times by FLOW 800 analysis showed a hemodynamically significant clip stenosis that might have been missed by conventional ICG-VAG and resulted in adjustment of the clip position. Overall, there was 1 cerebral infarction, which was not related to clip placement. CONCLUSIONS: FLOW 800 is a useful adjunct to ICG-VAG for intraoperative assessment of cerebral perfusion and may help to identify hemodynamically relevant clip stenosis. The beneficial impact of FLOW 800 on clinical outcome after microsurgical clipping needs to be confirmed by comparative studies.

Minimizing overdrainage with flow-regulated valves - Initial results of a prospective study on idiopathic normal pressure hydrocephalus.

OBJECTIVE: Overdrainage and frequent reprogramming are common issues with programmable valves after ventriculoperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (iNPH). Flow-regulated valves may address these limitations, but data on their efficacy are sparse. We present our single-center experience with flow-regulated valves focusing on overdrainage and efficiency. PATIENTS AND METHODS: Thirty-two patients with iNPH treated with the Integra® NPH Low Flow Valve were prospectively enrolled. Clinical evaluation was performed at baseline, postoperatively as well as 3 and 6 months after surgery. The outcome was assessed by employing the iNPH grading scale and the Mini Mental Status Examination (MMSE). Overdrainage was assessed clinically and radiologically by computed tomography. RESULTS: The mean patient age was 71 years. All patients presented with gait disturbance, 29 had cognitive impairment and 25 had urinary incontinence. The mean duration of symptoms was 22.9 months. At 3-month follow-up, 25/31 patients (80.6%) improved on the total iNPH score by at least 5 points (p < 0.001). The mean MMSE score increased from 24.5 to 26.1 points (p = 0.013). After 6 months, the improvement rates of the iNPH (82.1%) and the MMSE scores (26.8 points) were stable. The rate of clinically significant overdrainage was 3.2%. One patient presented with subdural hygromas that necessitated evacuation. In the remaining patients, clinical and radiological signs of overdrainage were absent. CONCLUSION: The use of the Integra® NPH Low Flow Valve leads to a good neurological outcome and has low overdrainage rates without the need for reprogramming. These results are encouraging and justify further investigation of this valve.