Comparison of the effects of stepwise intracranial decompression and decompressive craniectomy in the treatment of severe traumatic brain injury: A randomized controlled trial.

BACKGROUND: To compare the effects of stepwise intracranial decompression (SID) and decompressive craniectomy (DC) on severe traumatic brain injury. METHODS: This prospective randomized study was conducted at The Third Affiliated Hospital of Soochow University. Ninety two patients were divided into 2 groups according to the random number table method. The study group received SID, whereas the control group received DC. The surgical time and intraoperative bleeding of the 2 groups of patients were recorded, neurological function and glasgow coma score before and after treatment in both groups, incidence of complications, prognostic situation, and levels of brain oxygen metabolism indicators before and after treatment. RESULTS: Among the 92 patients who agreed, 46 were assigned to the study and control groups, and 6 patients were excluded. Finally, 86 patients were analyzed, including 43 in the study group and 43 in the control group. After treatment, the glasgow coma score scores of the 2 groups increased compared to before treatment; the study group had a higher score, The National Institutes of Health Stroke Scale score decreased compared to before treatment, and the study group had a lower score (P < .05). The incidence of complications in the study group (4.65%) was significantly lower than that in the control group (18.60%) (P < .05). The good prognosis rate of the research group (41.86%) was significantly higher than that of the control group (16.28%) (P < .05). CONCLUSION: Compared with DC, using SID to treat severe traumatic brain injury can shorten surgical time and reduce intraoperative bleeding, more effectively improve patients neurological function and consciousness state, reduce the incidence of complications, and regulate brain oxygen metabolism status, which is beneficial for improving prognosis and ensuring a good outcome of the disease.

Analysis of the risk factors for intraoperative acute diffuse brain swelling in patients with isolated traumatic acute subdural haematomas.

BACKGROUND: The purpose of this retrospective study was to investigate the risk factors for intraoperative acute diffuse brain swelling in patients with isolated traumatic acute subdural haematomas (ASDH). METHODS: A total of 256 patients who underwent decompressive craniectomy for isolated traumatic ASDH between April 2013 and December 2020 were included. We evaluated the risk factors for intraoperative acute diffuse brain swelling using a multivariate logistic regression analysis. RESULTS: The incidence of intraoperative acute diffuse brain swelling in patients with isolated traumatic ASDH was 21.88% (56/256). Dilated pupils (OR = 24.78), subarachnoid haemorrhage (OR = 2.41), and the time from injury to surgery (OR = 0.32) were independent risk factors for intraoperative acute diffuse brain swelling, while no independent associations were observed between these risk factors and sex, age, the mechanism of injury, the Glasgow Coma Scale score, site of haematoma, thickness of haematoma, midline shift and the status of the basal cistern, although the mechanism of injury, the Glasgow Coma Scale score and the status of the basal cistern were correlated with the incidence of intraoperative acute diffuse brain swelling in the univariate analyses. CONCLUSIONS: This study identified the risk factors for intraoperative acute diffuse brain swelling in patients with isolated traumatic ASDH. An increased risk of intraoperative acute diffuse brain swelling occurs in patients with bilaterally dilated pupils, subarachnoid haemorrhage and a shorter time from injury to surgery. These findings should help neurosurgeons obtain information before surgery about intraoperative acute diffuse brain swelling in patients with isolated traumatic ASDH.

Comparative risk for intracranial hemorrhage related to new oral anticoagulants: A network meta-analysis.

BACKGROUND: The intracranial hemorrhage (ICH) risk of oral anticoagulants/non-vitamin K antagonist oral anticoagulants (NOACs) remains largely unknown. Patients who need oral anticoagulants such as aspirin or warfarin often suffer from obvious complications. METHODS: This network meta-analysis intended to assess the ICH risk in patients taking NOACs. The data from PubMed, the Cochrane database, and Embase were reviewed. All phase III randomized controlled trials of NOACs (apixaban, edoxaban, dabigatran, rivaroxaban), aspirin and warfarin were reviewed. RESULTS: Twenty-three trials involving 137,713 participants were included, involving 6 regimens. Warfarin had the first risk of ICH (surface under the cumulative ranking area: 0.82), followed by dabigatran, edoxaban, aspirin, apixaban, rivaroxaban, and placebo. Dabigatran had the lowest risk of all-cause mortality (surface under the cumulative ranking area: 0.63), followed by apixaban, edoxaban, warfarin, rivaroxaban, aspirin, and placebo. CONCLUSION: Warfarin significantly increased the risk of ICH in patients taking oral anticoagulants compared with 4 NOACs (dabigatran, edoxaban, apixaban, rivaroxaban) and aspirin. Apixaban is least likely to induce all-cause mortality.

The coexistence of recurrent pituitary adenoma and meningioma: case report.

The coexistence of pituitary adenoma and meningioma is very rare. Here, we present a case of recurrent non-functioning pituitary adenoma and temporal lobe meningioma in a patient without previous irradiation. A 73-year-old woman underwent a right-sided craniotomy of pituitary adenoma for visual deficits 30 years ago. She presented again with a 2-year history of lack of alertness, confusion and visual deficits. Brain magnetic resonance imaging (MRI) demonstrated a recurrent pituitary adenoma and a left temporal lobe tumour. The patient underwent a left frontotemporal craniotomy. After the surgery, the patient showed improvement in neurological symptoms. The histology of the sellar region tumour revealed that it was a pituitary adenoma, and the histology of the temporal lobe tumour demonstrated that it was a meningioma of transitional type. The coexistence of pituitary adenoma and meningioma is a very rare surgical entity, especially in a patient with recurrent pituitary adenoma. Although this co-occurrence is rare, more cases and additional studies are necessary to explain these unusual findings.

Management of subdural effusion and hydrocephalus following decompressive craniectomy for posttraumatic cerebral infarction in a patient with traumatic brain injury: a case report.

BACKGROUND: Subdural effusion with hydrocephalus (SDEH) is a rare complication of traumatic brain injury, especially following decompressive craniectomy (DC) for posttraumatic cerebral infarction. The diagnosis and treatment are still difficult and controversial for neurosurgeons. CASE PRESENTATION: A 45-year-old man developed traumatic cerebral infarction after traumatic brain injury and underwent DC because of the mass effect of cerebral infarction. Unfortunately, the complications of traumatic subdural effusion (SDE) and hydrocephalus occurred in succession following DC. Burr-hole drainage and subdural peritoneal shunt were performed in sequence because of the mass effect of SDE, which only temporarily improved the symptoms of the patient. Cranioplasty and ventriculoperitoneal shunt were performed ultimately, after which SDE disappeared completely. However, the patient remains severely disabled, with a Glasgow Outcome Scale of 3. CONCLUSIONS: It is important for neurosurgeons to consider the presence of accompanying hydrocephalus when treating patients with SDE. Once the diagnosis of SDEH is established and the SDE has no mass effect, timely ventriculoperitoneal shunt may be needed to avoid multiple surgical procedures, which is a safe and effective surgical method to treat SDEH.

The Clinical Efficacy of Electromagnetic Navigation-Guided Hematoma Puncture Drainage in Patients with Hypertensive Basal Ganglia Hemorrhage.

OBJECTIVE: To investigate the clinical efficacy of navigation-guided minimally invasive surgery in patients with hypertensive basal ganglia hemorrhage. METHODS: A total of 64 patients with hypertensive basal ganglia hemorrhage were enrolled in this retrospective study. They were divided into a navigation group and a traditional group based on surgical approaches. The data for the 2 groups of patients were analyzed with regard for the hematoma clearance rate, duration of surgery, duration of hospitalization, Glasgow Outcome Scale score at discharge, Barthel index score at 6 months, and postoperative complication rates for rebleeding and pneumonia. RESULTS: There were no significant differences in basic characteristics between the 2 groups (P > 0.05). The hematoma clearance rate was significantly lower in the navigation group (49.18 ± 16.76%) than in the traditional group (84.29 ± 6.91%, P < 0.01). The duration of surgery and duration of hospitalization were significantly shorter in the navigation group (55.00 ± 11.89 minutes and 24.25 ± 7.1 days, respectively) than in the traditional group (156.38 ± 47.9 minutes and 32.63 ± 9.8 days, respectively; both P < 0.01). There were also significant differences between the 2 groups in Glasgow Outcome Scale scores (P = 0.006). The Barthel index scores were significantly greater in the navigation group (73.13 ± 18.76) than in the traditional group (57.63 ± 26.63, P < 0.05). There were no significant differences between the 2 groups in the complication rates (P > 0.05). CONCLUSIONS: Under certain conditions, compared with standard craniotomy and hematoma evacuation, navigation-guided hematoma puncture aspiration and catheter drainage is simple, effective, and safe as a treatment for hypertensive basal ganglia hemorrhage.

Behavioral and neurophysiological abnormalities during cued continuous performance tasks in patients with mild traumatic brain injury.

Objective: This study's aim was to investigate the features and neural mechanisms of sustained attention in patients with mild traumatic brain injury (mTBI) by comparing and analyzing neuropsychological, behavioral, event-related potentials, and event-related desynchronization and synchronization between mTBI patients and healthy controls. Methods: Twenty mTBI patients with mTBI and 20 healthy controls underwent the Mini-Mental State Examination (MMSE) and a cued continuous performance task (AX-CPT). Neuropsychological, behavioral, and electroencephalogram (EEG) data were collected and analyzed. Results: There were significant differences between the mTBI group and the control group in their MMSE total scores, attention, and calculation, but there were no significant differences in orientation, memory, recall, and verbal scores. There were significant differences between the mTBI group and the control group in hitting the number, reaction time, and the number of errors of omission, but there were no significant differences in the number of false errors. The amplitude of Go-N2 and Nogo-N2 was significantly smaller for the mTBI group than that for the control group. The amplitude of Go-P3 was significantly smaller for the mTBI group than that for the control group, but not for the amplitude of Nogo-P3. The Go-αERS were significantly less for the mTBI group than for the control group during the 0-200 ms after the stimulus onset. The Go-αERD and Nogo-αERD were significantly less for the mTBI group than for the control group during the 600-1,000 ms after the stimulus onset. The Go-ßERS were significantly less for the mTBI group than for the control group during the 200-400 ms after the stimulus onset. There were no significant differences in the Nogo-αERS and Nogo-ßERD/ERS between the mTBI group and the control group. Conclusion: Patients with mTBI exhibited impairments in sustained attention and conflict monitoring, while response inhibition may have been spared.

Management of Penetrating Brain Injury Caused by a Nail Gun: Three Case Reports and Literature Review.

BACKGROUND: Penetrating brain injury (PBI) caused by a nail gun is an extremely rare neurosurgical emergency that poses a challenge for neurosurgeons because of its rarity and complexity. CASE DESCRIPTION: Here we present 3 cases of PBI caused by a nail gun. In the first case, the nail entered through the right parietal bone and lodged in the right parietal lobe and basal ganglia. In the second case, the nail entered through the right occipital bone and lodged in the right occipital lobe. In the third case, the nail entered through the right parietal bone and lodged in the right frontal and parietal lobes. All patients underwent surgical removal of the nail. The first patient presented with reduced left-side strength, whereas the second and third patients were neurologically intact on presentation. CONCLUSIONS: PBI caused by a nail gun can present with differing clinical manifestations, and most cases require immediate surgery. A rational management strategy should provide a good postoperative prognosis with minimal neurologic deficits in these patients.

Two occurrences of delayed epidural hematoma in different areas following decompressive craniectomy for acute subdural hematoma in a single patient: a case report.

BACKGROUND: Delayed epidural hematoma (DEH) following evacuation of traumatic acute subdural hematoma (ASDH) or acute epidural hematoma (EDH) is a rare but devastating complication, especially when it occurs sequentially in a single patient. CASE PRESENTATION: A 19-year-old man who developed contralateral DEH following craniotomy for evacuation of a traumatic right-side ASDH and then developed a left-side DEH of the posterior cranial fossa after craniotomy for evacuation of the contralateral DEH. He was immediately returned to the operating room for additional surgeries and his neurological outcome was satisfactory. CONCLUSIONS: Although DEH occurring after evacuation of ASDH or acute EDH is a rare event, timely recognition is critical to prognosis.