Search

Objective: Chronic subdural hematoma (CSDH) is typically seen in elderly people with unilateral hemorrhages. The aim of this study was to examine the clinical outcomes of patients under the age of 50 who were treated at our clinic for bilateral CSDHs. Material and Method: This retrospective study included 20 patients under the age of 50 who had been diagnosed with bilateral CSDHs and treated with burr-hole drainage between 2000 and 2022 at Istanbul Faculty of Medicine, Department of Neurosurgery, Istanbul University. The patients’ demographic information, clinical data, and radiological images were obtained retrospectively from the hospital system. The data were subjected to descriptive statistical analysis using the IBM SPSS statistics 28.0.0 program. Result: There were 14 (70%) males and 6 (30%) females in our study, with a mean age of 20.5 years. The most common complaints among the patients were headaches in nine patients (45%), newly developed paresis in five patients (25%), and seizures in four patients (20%). It was discovered that 17 patients (85%) had no history of head trauma. CSDH was evacuated by bilateral burr-holes in 14 patients (70%). Three (21.4%) of 14 patients with bilateral burr-holes, and 3 (50%) of the remaining six patients were reoperated due to recurrent bleeding in the follow-up period. Conclusion: In our study, trauma history and use of antiaggregants and anticoagulants were low. More comprehensive studies on the etiology of bilateral CSDH in patients under 50 years of age are required. [ABSTRACT FROM AUTHOR]

Background There is an increasing incidence of chronic subdural hematoma due to extended life expectancy and associated trauma and fall risk. This retrospective study evaluates the efficacy of two burr-hole craniotomy over mini-craniotomy. Methods Sixty-five patients were recruited over 2 years, of which 56 were male and 9 were females. A patient with a chronic subdural hematoma either underwent burr-hole craniostomy or mini-craniotomy for hematoma evacuation. Glasgow coma scale (GCS) and modified Rankin score were used to assess the neurological status and interventional outcome at discharge and follow-up, respectively. A head CT scan was performed at 3 week and 3 month follow-up. Statistical Analysis Categorical data are presented as frequency and percentage, while non-categorical data are represented as mean ± SD. Statistical significance for difference in outcome between the two groups was analyzed using the chi-square test and p -value less than 0.05 was considered statistically significant. Results The mean age of patients was 55.6 years. Headache (35 cases), hemiparesis, and altered sensorium were seen in 20 patients, each with the main presenting symptoms. Trauma history was noted in 69.2% of patients. One (3.7%) hematoma recurrence in the burr-hole group and four (8.3%) in the mini-craniotomy group was recorded. The mean operative time was longer in the minicraniotomy group (124.2 min vs. 75.4 min; p < 0.001). A higher incidence of recurrence was noted in the craniotomy group (8.3%) than the burr-hole group (3.7%). No statistical difference in the recurrence rate, duration of hospital stay, GCS at discharge, modified Rankin score between the two study groups at discharge was noted. Conclusion Two burr-hole craniostomy is a safe and effective surgical option to treat chronic subdural hematoma. It is also validated in patients on anticoagulants and antiplatelet medications with adequate pre-surgical correction of coagulation parameters. [ABSTRACT FROM AUTHOR]

Background Factors determining the recurrence of chronic subdural hematomas (CSDHs) are not clear. Whether opening the so-called internal hematoma membrane is useful has not been investigated. Objective To investigate whether splitting the inner hematoma membrane influences the recurrence rate in patients undergoing burr-hole craniotomy for CSDH. Methods Fifty-two awake patients undergoing surgery for 57 CSDHs were prospectively randomized to either partial opening of the inner hematoma membrane (group A) or not (group B) after enlarged burr-hole craniotomy and hematoma evacuation. Drainage was left in situ for several days postoperatively. Groups were comparable with regard to demographic, clinical, and imaging variables. Outcome was assessed after 3–6 weeks for the combined outcome variable of reoperation or residual hematoma of one third or more of the original hematoma thickness. Results Fourteen patients underwent reoperation for clinical deterioration or residual hematoma during follow-up ( n = 6 in group A, 21%; n = 8 in group B, 28 %) ( P = 0.537). Residual hematoma of ≥ one third not requiring surgery was present in 7 patients in group A (25%) and 10 patients in group B (36%) ( P = 0.383). The overall cumulative failure rate (reoperation or hematoma thickness ≥ one third) was 13/28 (46%) in group A and 18/28 in group B ( P = 0.178; relative risk, 0.722 [95% confidence interval, 0.445–1.172]; absolute risk reduction –16% [95% confidence interval, –38% to 8%]). Conclusions Opening the internal hematoma membrane does not alter the rate of patients requiring revision surgery and the number of patients showing a marked residual hematoma 6 weeks after evacuation of a CSDH. [ABSTRACT FROM AUTHOR]

Objective To determine whether the use of a subdural drain after burr-hole evacuation of a chronic subdural hematoma is safe and effective in preventing recurrence and subsequent operations, and as such improving functional outcomes. Methods The literature search included the following databases: PubMed, the National Institutes of Health/National Library of Medicine, Clinical Trials Registry, CENTRAL (The Cochrane Library), EMBASE, and LILACS. The search was performed in June 2013, and did not have restrictions or filters with regard to language or year of publication. Methodologic quality was assessed through the Jadad's scale. Primary outcomes were recurrence and reoperation rates. Secondary outcomes were functional outcome, mortality, and postoperative complications. Results were presented as pooled Mantel-Haenszel relative risks (RR), with 95% confidence intervals (95% CI). Results A total of 7 randomized controlled trials were analyzed. Three studies were classified as high methodologic quality and four as low quality. Pooled RR were symptomatic recurrence (RR 0.51; 95% CI 0.36–0.75), reoperation (RR 0.5; 95% CI 0.34–0.74), poor functional outcome (RR 0.61, 95% CI 0.39–0.98), mortality (RR 0.67, 95% CI 0.37–1.22), and postoperative complications (RR 1.28, 95% CI 0.78–2.11). There was no statistically significant heterogeneity within the outcomes. Conclusions The meta-analysis demonstrates that the insertion of a subdural drain was associated with a statistically significant reduction in the risk of symptomatic recurrence and the requirement for further surgical intervention of chronic subdural hematoma after surgical evacuation. Furthermore, it was associated with statistically significant improvements in both short-term and long-term functional outcome. [ABSTRACT FROM AUTHOR]

Objective : To analyze the clinical data and surgical results from symptomatic chronic subdural hematoma (CSDH) patients who underwent burr-hole drainage (BHD) at the maximal thickness area and twist-drill craniostomy (TDC) at the precoronal point. Methods : We analyzed data from 65 symptomatic CSDH patients who underwent TDC at the pre-coronal point or BHD at the maximal thickness area. For TDC, we defined the pre-coronal point to be 1 cm anterior to the coronal suture at the level of the superior temporal line. TDC was performed in patients with CSDH that extended beyond the coronal suture, as confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed and analyzed. Results : Of the 65 CSDH patients, 13/17 (76.4%) with BHD and 42/48 (87.5%) with TDC showed improved clinical performance and radiological findings after surgery. Catheter failure was seen in 1/48 (2.4%) cases of TDC. Five patients (29.4%) in the BHD group and four patients (8.33%) in the TDC group underwent reoperations due to remaining hematomas, and they improved with a second operation, BHD or TDC. Conclusion : Both BHD at the maximal thickness area and TDC at the pre-coronal point are safe and effective drainage methods for symptomatic CSDHs with reasonable indications. [ABSTRACT FROM AUTHOR]

Background: Chronic subdural haematoma is one of the most common clinical conditions encountered in neurosurgical practice. The surgical approaches exhibit a wide spectrum ranging from simple burr-hole to complex craniotomy with excision of membrane. We tried to approach this condition with a procedure that is safer and faster using a single burr-hole for drainage and a technique of "syringing" the subdural space with normal saline for irrigation. Aims: We describe our technique of single burr-hole drainage and normal saline irrigation using the technique of "syringing". Settings and design: This is a retrospective study wherein we analysed the data of the treated patients contained in the case sheets, operation theatre records and hospital discharge summaries. Methods and material: Hundred fifty patients who had chronic subdural haematoma were treated surgically from April 2010 to March 2013. All the patients were operated under general anaesthesia. The clinical data at admission, discharge and 3 weeks following discharge was analysed as per the records. Results: Favourable outcome was seen in all the 150 patients treated. None of the patients had any recurrence. Superficial wound infection was seen in only one patient which subsided with antibiotics. Conclusions: Single burr-hole drainage and saline irrigation using the technique of "syringing" is a simple, fast and safe procedure for treating chronic subdural haematoma with a favourable outcome. [ABSTRACT FROM AUTHOR]

Abstract: Objective: For long-term preservation of ventriculo-peritoneal (VP) shunt function, it is essential to place the ventricular catheter tip above the foramen of Monro. But the free-hand technique for ventricular catheter passage is not consistent. Methods: Supposing that a convex of skull matches to a sphere, in which the foramen of Monro is the center, a perpendicular direction from the surface of the sphere to inside always directs toward the center. The authors identified the range of skull where corresponded to the sphere by magnetic resonance imaging assessment and utilized tripod to achieve exactly perpendicular insertion of ventricular catheter. And an optimal length of catheter insertion was investigated by navigation system. Results: The anterior–posterior range of the spherical portion was from coronal suture to 20mm anterior, and the lateral range of it was between 15 and 35mm lateral from sagittal suture. The optimal catheter length for insertion was between 55 and 58mm from the brain surface. Ideal placement of a ventricular catheter tip was achieved in more than 90% of cases (31/34) with this technique. Conclusion: Tripod-guided ventricular catheter insertion is a simple and reliable method for VP shunt at any angle of head-rotation. [Copyright &y& Elsevier]

Chronic subdural hematoma (cSDH) is an increasingly common neurological disease process. Despite the wide prevalence of cSDH, there remains a lack of consensus regarding numerous aspects of its clinical management. We provide an overview of the epidemiology and pathophysiology of cSDH and discuss several controversial management issues, including the timing of post-operative resumption of anticoagulant medications, the effectiveness of anti-epileptic prophylaxis, protocols for mobilization following evacuation of cSDH, as well as the comparative effectiveness of the various techniques of surgical evacuation. A PubMed search was carried out through October 19, 2010 using the following keywords: 'subdural hematoma', 'craniotomy', 'burr-hole', 'management', 'anticoagulation', 'seizure prophylaxis', 'antiplatelet', 'mobilization', and 'surgical evacuation', alone and in combination. Relevant articles were identified and back-referenced to yield additional papers. A meta-analysis was then performed comparing the efficacy and complications associated with the various methods of cSDH evacuation. There is general agreement that significant coagulopathy should be reversed expeditiously in patients presenting with cSDH. Although protocols for gradual resumption of anti-coagulation for prophylaxis of venous thrombosis may be derived from guidelines for other neurosurgical procedures, further prospective study is necessary to determine the optimal time to restart full-dose anti-coagulation in the setting of recently drained cSDH. There is also conflicting evidence to support seizure prophylaxis in patients with cSDH, although the existing literature supports prophylaxis in patients who are at a higher risk for seizures. The published data regarding surgical technique for cSDH supports primary twist drill craniostomy (TDC) drainage at the bedside for patients who are high-risk surgical candidates with non-septated cSDH and craniotomy as a first-line evacuation technique for cSDH with significant membranes. Larger prospective studies addressing these aspects of cSDH management are necessary to establish definitive recommendations. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Stereotactic biopsy is a widely used surgical technique for the histological diagnosis of intracranial lesions. Potential risks of this procedure, such as hemorrhage, seizure, and infection have been established, and different risk factors have been characterized. However, these risks have been addressed by only few studies conducted in Asian countries. Materials and methods: The study group is comprised of 299 consecutive stereotactic biopsy procedures by 11 neurosurgeons between 2004 and 2007. The pre-operative medical conditions, methods of biopsy and postoperative complications were analyzed. Result: The overall diagnostic yield was 90.64%. Complications were observed in 7.36% of the cases, with symptomatic hemorrhages occurring in 4.35% of the cases, and the overall mortality rate in this study population was 1.34%. Patients with liver cirrhosis were at a higher risk of hemorrhage. Other clinical, radiological, or histological variables were not associated with an increased risk of complications. Conclusion: Stereotactic brain biopsy is a safe and reliable way to obtain a histological diagnosis. Based on our recent clinical experiences, the data suggests that more attention should be paid to liver cirrhotic patients, since the chance on hemorrhage is significantly larger. [Copyright &y& Elsevier]

Unplanned migration of a deep brain stimulation (DBS) electrode after accurate placement at the intended target can result in a poor surgical outcome and added cost to the procedure. There are various fixation methods described in the literature. The authors describe the use of a modified burr-hole cover which serves as a simple and cost-effective method of fixation of the DBS lead with excellent results. [ABSTRACT FROM AUTHOR]