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1.
World Neurosurg ; 156: e266-e275, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34543731

RESUMO

OBJECTIVE: Venous hypertension associated with a primitive basal vein of Rosenthal (BVR) has been noted as the most likely cause of idiopathic subarachnoid hemorrhage (iSAH). Other types of venous drainage variations have been scarcely studied but may further explain the cases not associated with a BVR anomaly. Our aim was to investigate if dural venous sinus (DVS) anomalies are related with iSAH. METHODS: A total of 76 patients diagnosed with iSAH were identified from a prospectively maintained database and their angiographic findings compared with 76 patients diagnosed with aneurysmal subarachnoid hemorrhage. RESULTS: On top of the BVR variations, our data showed a higher prevalence of transverse sinus hypoplasia (47.4% vs. 28.9%; P = 0.019), superior petrosal sinus hypoplasia (32.9% vs. 13.2%; P = 0.003), and clival plexus hyperplasia (65.8% vs. 43.4%; P = 0.005) in patients with iSAH. Analyzing by total number of angiograms, the iSAH group showed also a higher prevalence of inferior petrosal sinus hyperplasia (36.2% vs. 25%; P = 0.003). Of the patients with iSAH without a primitive BVR, 84% harbored ≥1 perimesencephalic DVS variation and the overall number of venous drainage variations was significantly higher in patients with iSAH. CONCLUSIONS: In addition to the well-documented BVR anomalies, there seems to be a significant relationship of other DVS variations in patients with iSAH. Transverse sinus hypoplasia, superior petrosal sinus hypoplasia, inferior petrosal sinus hyperplasia, and clival plexus hyperplasia were significantly more frequent in patients with iSAH. The presence of ≥3 of those variations would increase the suspicion of a nonaneurysmatic subarachnoid hemorrhage and could help avoid a second angiogram.


Assuntos
Cavidades Cranianas/patologia , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/patologia , Angiografia Cerebral , Veias Cerebrais/fisiopatologia , Cavidades Cranianas/anormalidades , Bases de Dados Factuais , Feminino , Humanos , Hiperplasia/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Amostragem do Seio Petroso , Estudos Prospectivos , Seios Transversos/anormalidades , Seios Transversos/diagnóstico por imagem
2.
Childs Nerv Syst ; 37(12): 3817-3826, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34319438

RESUMO

BACKGROUND: Stereo-electroencephalography (SEEG) is a well-known invasive diagnostic method for drug-resistant epilepsy (DRE). Its rate of complications is relatively low, being the intracranial hemorrhage (ICH) the most relevant. Most centers perform immediate imaging studies after SEEG to rule out complications. However, delayed intracranial hemorrhages (DIH) can occur despite normal imaging studies in the immediate postoperative period. METHODS: We performed a retrospective review of DRE pediatric patients operated on SEEG between April 2016 and December 2020 in our institution. After implantation, an immediate postoperative CT was performed to check electrode placement and rule out acute complications. An additional MRI was performed 24 h after surgery. We collected all postoperative hemorrhages and considered them as major or minor according to Wellmer´s classification. RESULTS: Overall, 25 DRE patients were operated on SEEG with 316 electrodes implanted. Three ICHs were diagnosed on postoperative imaging. Two of them were asymptomatic requiring no treatment, while the other needed surgical evacuation after clinical worsening. The total risk of hemorrhage per procedure was 12%, but just one third of them were clinically relevant. Two hemorrhages were not visible on immediate postoperative CT, being incidentally diagnosed in the 24 h MRI. We recorded them as DIH and are reported in detail. CONCLUSION: Few reports of DIH after SEEG exist in the literature. It remains unclear whether these cases are late occurring hemorrhages or immediate postoperative hemorrhages undiagnosed on initial imaging. According to our findings, we recommend to perform additional late postoperative imaging to diagnose these cases and manage them accurately.


Assuntos
Diagnóstico Tardio , Epilepsia Resistente a Medicamentos , Criança , Epilepsia Resistente a Medicamentos/cirurgia , Eletrodos Implantados , Eletroencefalografia , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Estudos Retrospectivos , Técnicas Estereotáxicas
3.
Acta Neurochir (Wien) ; 163(3): 743-751, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33389122

RESUMO

BACKGROUND: Currently available scores for predicting shunt dependency after aneurysmal spontaneous subarachnoid hemorrhage (aSAH) are limited and not widely accepted. The key purpose of this study was to validate a recently created score for shunt dependency in aSAH (SDASH) in an independent population of aSAH patients. We compared this new SDASH score based on a combination of the Hunt and Hess grade, Barrow Neurological Institute (BNI) score, and the presence or not of acute hydrocephalus with other published predictive scores. METHODS: The SDASH score, Hijdra score, BNI grading system, chronic hydrocephalus ensuing from SAH score (CHESS), Graeb score, and modified Graeb score (mGS) were calculated for a cohort of aSAH patients. Logistic regression analysis was used to determine the reliability of the SDASH score, and the area under the curve (AUC) of the receiver operating characteristics (ROC) curve was used to assess the discriminative ability of the model. RESULTS: In 214 patients with aSAH, 40 (18.7%) developed shunt-dependent hydrocephalus (SDHC). The AUC for the SDASH score was 0.816. The SDASH score reliably predicted SDHC in aSAH (odds ratio: 2.93, 95% CI: 1.99-4.31; p < 0.001) with no statistically significant differences being found between the SDASH score and the CHESS score (AUC: 0.816), radiological-based Graeb score (AUC: 0.742), or modified Graeb score (AUC: 0.741). However, the Hijdra score (AUC: 0.673) and BNI grading system (AUC: 0.616) showed lower predictive values than the SDASH score. CONCLUSIONS: Our findings support the ability of the SDASH score to predict shunt dependency after SAH in a population independent to that used to develop the score. The SDASH score may aid in the early management of hydrocephalus in aSAH, and it does not differ greatly from other predictive scores.


Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Hidrocefalia/epidemiologia , Aneurisma Intracraniano/cirurgia , Complicações Pós-Operatórias/epidemiologia , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Feminino , Humanos , Hidrocefalia/patologia , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Prognóstico , Hemorragia Subaracnóidea/patologia
4.
World Neurosurg ; 140: 32-36, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32437989

RESUMO

BACKGROUND: The present study aims to draw attention to the fact that endurance sport could be a risk factor for dural arteriovenous fistula (DAVF) development. DAVFs have been correlated with acquired dural venous sinus anomalies owing to trauma, infection, neoplasia, or other classic risk thrombogenic factors. Here we report 3 cases of intracranial DAVF in young healthy patients who had no known thrombogenic risk factors other than amateur intensive sports practice. CASE DESCRIPTION: Three young healthy individuals not fitting into the classical clinical picture of a DAVF patient presented to our institution. One was a 40-year-old man with an acute subdural hematoma secondary to an ethmoidal DAVF. Another 41-year-old man presented with a cerebellar hematoma due to a tentorial DAVF. A third 41-year-old man presented with numbness of his right arm in relationship to a superior sagittal sinus DAVF. None of them had a relevant medical history. All the usual thrombogenic risk factors for DAVF development were ruled out. Interestingly, the 3 patients had outstanding training and practice routines for endurance sports. CONCLUSIONS: Dehydration, microfractures, muscular contractures, low heart rate, long distance travel, and high altitudes are all well documented thrombogenic risk factors affecting endurance sports amateur athletes and might represent a plausible mechanism for the development of DAVF. Despite its limitations, to our knowledge, this is the first work suggesting a possible link between such sport practice and DAVF development. Further prospective research from larger dedicated vascular centers might shed further light on this hypothetic but intriguing link.


Assuntos
Atletas , Malformações Vasculares do Sistema Nervoso Central/etiologia , Treino Aeróbico/efeitos adversos , Adulto , Humanos , Masculino , Fatores de Risco
6.
Acta Neurochir (Wien) ; 161(11): 2233-2240, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31489530

RESUMO

BACKGROUND: Management of asymptomatic meningiomas represents a challenge due to the absence of a solid consensus on which is the best management strategy. There are various known factors predicting meningiomas growth risk. However, the Asian Intracranial Meningioma Scoring System (AIMSS) is the only described score to quantify such risk thus emerging as a potential tool for management decisions. This study aims to validate this score on our series of asymptomatic meningiomas. METHOD: We performed a retrospective review of asymptomatic meningiomas diagnosed at our institution between January 2008 and October 2016 and followed by an annual cerebral Magnetic Resonance Imaging (MRI). For each lesion, the AIMSS score was calculated thus classifying them in low (0-2), intermediate (3-6) or high risk (7-11) of rapid growth (>2cm3/year). We investigated the correlation between the expected Average Growth Rate (AGR) according to the score and the one obtained in our study. The mean growth velocity over the different risk groups was also compared. RESULTS: Overall, 69 asymptomatic meningiomas found incidentally in 46 patients were included in the study; 31 were assigned to the low-risk group, 34 to the intermediate-risk group and 4 to the high-risk group. Attending to the AGR, 0% showed rapid growth in the low-risk group, 12% in the intermediate-risk group, and 25% in the high-risk group. The mean growth velocity showed a significant difference over the different risk groups (p < 0,001). CONCLUSIONS: According to our finding, the AIMSS score is a valid tool to estimate the risk of rapid growth of asymptomatic meningiomas. It is especially useful distinguishing between low- and intermediate-risk meningiomas. This feature would allow physicians to adjust the periodicity of radiological and clinical controls. Adding more known risk factors of rapid growth to the score might improve its predictive capabilities with the high-risk group.


Assuntos
Imageamento por Ressonância Magnética/normas , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Índice de Gravidade de Doença , Adulto , Idoso , Algoritmos , Povo Asiático , Doenças Assintomáticas , Feminino , Humanos , Masculino , Neoplasias Meníngeas/patologia , Meningioma/patologia , Pessoa de Meia-Idade
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