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Introduction Optimal surgical treatment for chronic subdural hematoma (CSDH) in the elderly has been controversial. Whenever possible, a less invasive technique should be used to avoid complications.

Introduction: Chronic subdural hematoma is a common entity in neurosurgery. Currently, multiple therapeutic modalities are described and surgical evacuation with endoscopic support is increasingly used. Objective: To describe the surgical results of endoscopic support in patients with chronic subdural hematoma. Method: A descriptive and retrospective study was carried out, which included 31 patients, at the Hermanos Ameijeiras hospital, operated on for chronic subdural hematoma using transcranial approaches with endoscopic support. Sociodemographic, clinical, imaging, surgical and complications related to the procedure variables are described. For data analysis, absolute and relative frequencies were used. Results: The most used surgical technique was using 2 burr holes with endoscopic support (83.9 %). Total evacuation was reported in 96.8 % of patients. Postoperative complications identified (3.2 %) were: Pneumocephalus, residual hematoma, and recurrence. Conclusions: Endoscopic support in the surgical evacuation of chronic subdural hematomas constitutes a safe and effective method with a significant reduction in postoperative complications, especially in the incidence of hematoma recurrence.

Calcified chronic subdural hematomas (CCSDHs) are rare entities, whose yearly incidence ranges from 1.72 to 20.6 per every 100 thousand persons. Several different approaches to their management are reported in the literature, ranging from conservative treatment to craniotomy with full removal of the neomembranes. Currently, there are no guidelines or consensus that establish the best technique. We herein report a case of symptomatic CCSDH initially drained through a burr-hole craniotomy, with no resolution of the symptoms. Later, our patient underwent a craniotomy and partial membranectomy, which resulted in full symptomatic recovery.

Copyright of Revista de Ciencias Médicas de Pinar del Río is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Chronic subdural hematoma is a frequent neurosurgical illness, and current treatment options mostly include subdural trepanation and drainage alone, as well as middle meningeal artery embolization in conjunction with subdural trepanation and drainage. However, there is currently a lack of extensive study and data support for comparing the clinical results of the two surgical treatment techniques., Objective: The goal of this study is to compare the clinical effects of middle meningeal artery embolization combined with subdural trepanation and drainage versus simple subdural trepanation and drainage in the treatment of chronic subdural hematoma, in order to provide a reliable foundation for clinical selection of appropriate surgical treatment methods., Methods: This study included 71 patients with chronic subdural hematoma, who were divided into two groups according to the procedure: observation group (n = 25) and control group (n = 46). The control group received only basic subdural drilling and drainage., Conclusions: This study found that MMA embolization combined with subdural trepanation and drainage provides a greater therapeutic benefit in the treatment of chronic subdural hematoma. The observation group outperformed the control group in terms of postoperative CT results, Barthel index, and clinical effect, as well as operating time. Furthermore, the observation group's complications and recurrence rate were much lower than the control group's., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Chronic subdural hematoma is one of the most frequent neurosurgical diseases treated by neurosurgeons. Its incidence has been increasing due to the increase in the elderly population and the use of anticoagulants. The success of neuroendoscopy for its treatment has recently been reported. Objective: To describe the result of neuroendoscopic treatment of a patient with post-traumatic chronic subdural hematoma. Clinical case report: The case of an 89-year-old male patient is reported here. He suffered a fall from his feet and received a head injury in the frontal region, 45 days before admission. Ten days prior to admission, he began to speak incoherently and also had difficulty walking. An axial tomography of the skull was performed in which a left hemispheric blood collection of mixed densities was visualized, with a mass effect on the midline structures, typical of a chronic subdural hematoma. A transcranial neuroendoscopic approach was performed using a left parietal trephine, with evacuation of the hematoma and placement of an external drainage catheter. He was seen in consultation one month, six months and two years after surgery, with image control and disappearance of the hematoma. He was seen in consultation one month, six months and two years after surgery, image control was performed and the hematoma disappeared. Conclusions: The endoscopic transcranial approach in an 89-year-old patient was effective in the evacuation of a post-traumatic chronic subdural hematoma and the placement of an external drainage catheter. The clinical and imaging evolution was good and with no complications after two years of follow-up. [ABSTRACT FROM AUTHOR]

Durante la pandemia COVID-19 se ha incrementado el uso de la telemedicina y de plataformas virtuales en el campo de la medicina, por ello en nuestra institución contamos con un sistema multicámara que permite la visualización en vivo de procedimientos endovasculares. Se realizaron once casos de aneurismas, malformaciones arteriovenosas y hematomas subdurales crónicos que fueron tratados y transmitidos en vivo sin problemas técnicos a través de la plataforma Zoom®. El tiempo promedio de transmisión y del número de participantes fue de 2.5 horas y 6 participantes, respectivamente. En todos los casos se discutió la técnica empleada y las complicaciones ocurridas. El aprendizaje remoto con plataformas en línea es hoy en día una herramienta importante, pero no un sustituto del aprendizaje práctico para procedimientos endovasculares. Recomendamos su implementación durante la pandemia de COVID-19 como un sustituto temporal, especialmente para los médicos en entrenamiento que no tienen acceso a intervenciones endovasculares avanzadas.

Introduction: Chronic subdural hematoma (cSDH) is a prevalent neurosurgical condition with an increasing incidence due to the rising life expectancy and the widespread use of anticoagulant and antiplatelet therapies. Insights into the inflammatory origins of cSDH led to the exploration of Middle Meningeal Artery (MMA) embolization as a therapeutic strategy. In recent years the endovascular treatment of MMA has gained momentum. Herein we present the initial experience of a dual trained neurovascular unit implementing this therapeutic technique., Methods: This single-center, prospective pilot study aimed to evaluate the feasibility, safety, and efficacy of MMA embolization in the treatment of cSDH. Following ethical approval and informed consent, demographic, clinical, and radiological data were collected. Patients requiring emergent surgical treatment were excluded. The study focused on assessing clinical outcomes, including the Modified Rankin Score (mRS) and volumetric analysis of cSDH, before and after embolization., Results: Fifteen patients underwent MMA embolization, with a predominance of males (80%) and a mean age of 72.4 years. The most common presenting symptom was headache (53.3%). The average hospital stay was 3.9 days. Various embolization techniques were employed, with DMSO-EVOH being the most frequent. All procedures were successfully conducted without complications. Although not statistically significant, trends suggested better outcomes in patients with homogeneous cSDH on the CT scan, displaying the cotton wool sign on angiography and treated with EVOH-DMSO., Conclusion: MMA embolization for cSDH demonstrates promise as a safe and effective treatment, potentially reducing the need for surgical intervention and recurrence rates. This study lays the groundwork for a larger, randomized controlled trial which protocol is herein presented., (Copyright © 2024 Sociedad Española de Neurocirugía. Published by Elsevier España, S.L.U. All rights reserved.)

Background and Objectives: Chronic subdural hematoma (CSDH) is one of the most common pathologies in our daily practice. The standard treatment is the evacuation making a burr-hole and placement of a subdural drainage, which has shown to decrease its recurrence. However, this procedure can entail risks such as parenchymal damage, infection, or the onset of seizures, prompting the consideration of subgaleal drainage as an alternative. Our objective is to compare the use of subdural and subgaleal drainage in a cohort of patients undergoing intervention for CSDH, as well as to analyze the differences in complication rates and recurrence between the two groups., Methodology: A retrospective analytical observational study was conducted, analyzing 152 patients diagnosed with CSDH who underwent intervention at our center from January 2020 to April 2022. Patients in whom drainage was not placed were excluded. In all patients, a burr-hole was performed and the type of drainage was chosen by the neurosurgeon., Results: Out of the 152 patients, subdural drainage was placed in 80 cases (52.63%), while subgaleal drainage was used in 72 cases (47.37%). There were no significant differences in the recurrence rate (30% in the subdural drainage group vs. 20.83% in the subgaleal drainage group; P = .134) or in the complication rate (7.5% in the subdural drainage group vs. 5.5% in the subgaleal drainage group; P = .749)., Conclusions: Subgaleal drainage shows similar clinical outcomes with a recurrence and complication rate comparable to subdural drainage, suggesting it as a safe and effective alternative to subdural drainage in the treatment of CSDH., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To describe a patient who had dural metastases, as a form of presentation of a prostate adenocarcinoma. Clinical case report: An 81-year-old patient went to the emergency room, with no previous diagnosis of prostate carcinoma, who had progressive headache. Computerized axial tomography was performed, which revealed an image suggestive of chronic, bilateral subdural hematoma, with isodense, nodular lesions, located in the dura mater distribution territory. The pathological anatomy study showed that they were metastatic lesions. Subsequently, prostate adenocarcinoma was identified. The patient did not receive complementary cancer treatment due to family decision. Conclusion: Dural metastases from prostatic adenocarcinoma are rare; however, they should be included in the differential diagnosis of progressive headache in men over 70 years of age with or without a history of malignant prostate tumors. [ABSTRACT FROM AUTHOR]

Objective: To describe a rare case of carcinomatous meningitis in a patient with lung cancer who presented with recurrent chronic subdural hematoma. Clinical case report: We report the case of a 57-year-old male patient with a history of being an inveterate smoker and a diagnosis of lung neoplasia. His study revealed cranial metastasis in the left parietal region. While awaiting oncological treatment for his primary neoplasm, he began to suffer headaches and right hemiparesis. A left hemispheric chronic subdural hematoma was verified in computerized axial tomography. Surgery was performed on it, a month later it was collected. A leptomeningeal carcinomatosis was suspected, which was confirmed by histological study of the membrane. The patient died due to compression syndrome of the superior vena cava, secondary to lung neoplasia. Conclusions: The recurrent chronic subdural hematoma described was caused by carcinomatous leptomeningitis and it was of interest because it was the first to be diagnosed. Skull tomography helped the diagnosis and behaved as a poor prognostic factor. Surgical treatment in this case was the choice and the unfavorable evolution of the patient did not give an option to oncological treatment. [ABSTRACT FROM AUTHOR]

Copyright of Surgical Neurology International is the property of Scientific Scholar LLC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Chronic subdural hematoma is one of the most common clinical entities in everyday neurosurgical practice, which incidence and prevalence increase considerably with age. Conservative treatment can be very useful in many patients. Objective: To show that the exclusive pharmacological management of this condition can be considered in many patients. Clinical cases: Two elderly patients attended at the neurosurgery service are presented with a diagnosis of chronic subdural hematoma. They were treated only with drugs. Conclusions: The final result was the reabsorption of the subdural collections, which was proven by imaging studies.

Objective: To identify the behavior of the electrolytic and gasometric components of the blood contained in chronic subdural hematomas and to relate them with their growth and expansion. Methods: A pre-external study was carried out with 20 adult patients surgically treted by chronic subdural hematoma, in the Neurosurgery Service, at Roberto Rodríguez General Teaching Hospital, from Ciego de Ávila, from January to December 2019. The ANOVA test of a single direction was used to determine which sociodemographic variables were related to the results and what hemochemical and gas variables were linked to the growth of the thickness of hematoma. The variables age, sex and Markwalder scale were used, as well as the excess base, pH and PACO2. The Pearson Bivariate Correlation Test was also carried out to evaluate the linear relationship between two variables. Results: The Markwalder scale at hospitalization evidenced higher incidence of grades II and III, with 7 (35%) and 9 cases (45%), respectively. Those over 60 years (95%) predominated and the volumes of the upper hematoma of 40 cm3 (70%) were more frequent. The Glasgow results scale showed grade V predominance (70%). Conclusions: Gasometric characteristics showed the decrease of excess base, normal or acid pH and the increase in subdural Blood PACO2. The electrolytic components of the blood seem to have participation in the accumulation and subsequent growth of hematoma. [ABSTRACT FROM AUTHOR]

El hematoma subdural crónico (HSDC) es una patología neuroquirúrgica frecuente, con una recurrencia de hasta el 30% de los casos. La embolización de la arteria meníngea media (AMM) es una estrategia de manejo adyuvante para disminuir la recidiva, especialmente en pacientes con factores de riesgo para recurrencia, y tiene una baja tasa de complicaciones. Presentamos el caso de un varón de 83 años con antecedente de anticoagulación, que es admitido en centro sanitario por presentar hemiparesia derecha, disartria y alteración de la marcha, con un tiempo de enfermedad de una semana. Se realizó trepanación y evacuación del HSDC sin complicaciones. Un mes después retornó por recidiva del HSDC, por lo que se realizó trepanación y evacuación adecuada del HSDC, seguida de embolización de la AMM ipsilateral. El control a los dos meses mostró ausencia de recidiva, con mejoría neurológica del paciente. Concluimos que la embolización de la AMM fue un tratamiento adyuvante eficaz para disminuir la recidiva del HSDC y podría estar indicada en pacientes con factores de riesgo asociados a la recurrencia.

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chronic Subdural Hematoma (CSH) is one of the most common problems encountered in neurosurgical practice and the main cause of neurosurgical care in the elderly population. Objective: The objective is topresent epidemiological data, pathophysiology, risk factors, diagnosis and treatment of (CSH). Material and methods: A retrospective, observational and descriptive study was carried out from March 2013 to March 2017. The analysis of clinical records and the automated system of hospital discharges we found that all of the patients required drainage of (CSH) at the General Hospital "MaríaIgnacia Gandulfo". Results: We report 65 procedures for drainage of (CSH), finding a male-female ratio of 4: 1. The incidence was higher in patients between 60 to 80 years old. Theannual prevalenceis 5.3 per 100 000 inhabitants (0.0053%). Traumatic etiology was the main cause for (CSH), with 41 cases reported (63.07%). Fifty percent of the cases (51.56%) were related to falls from standing and 5 (10.94%) were related to falls from equines. Headache was the most frequently symptom or sign that motivated the search for medical attention (35.94%) In 45 (69.2%) of the cases, both craniotomy (trephnae) and placement of probes was thesurgicalapproach,In 20 cases (30.7%) only the craniotomy was performed, 3 (4.6%) patients were submitted to a second round of craniotomy and drainage. There were 2 (3.07%) deaths. Conclusion: Chronic subdural hematoma is one of the most prevalent neurosurgical pathologies worldwide, the importance of knowing it is that it is more frequent in the elderly population. [ABSTRACT FROM AUTHOR]

Chronic calcified subdural hematoma or “shielded brain” is a rare finding within neurosurgical practice, constituting 0.3% to 2.7% of subdural hematomas. The pathophysiological mechanism by which it develops is still unknown, however, it has been proposed that poor circulation in the subdural space and thrombosis predispose to its formation. Clinical Case: The case of a 30-year-old female with a history of hydrocephalus with right ventriculoperitoneal shunt since the age of 3 years is reported, who presents with a history of headache that did not improve with analgesics, without other neurological alteration. A simple brain tomography was performed, which revealed a hypodense bilateral extra-axial collection with perilesional calcification suggestive of chronic calcified subdural hematoma. A left temporo-parietal craniotomy and right trephine were performed for exploration and evacuation of both hematomas without complications. Conclusion: The calcification of a chronic subdural hematoma is a rare entity, so it is necessary to consider it within the differential diagnoses for findings suggestive of intracranial calcifications. Its handling is still controversial. Surgical treatment may be a good choice in patients with mass effect symptoms. However, it is possible to provide conservative management in asymptomatic patients, so individualized management is necessary for each patient. [ABSTRACT FROM AUTHOR]

Objetivo: Avaliar o tratamento cirúrgico do hematoma subdural crônico em pacientes idosos, com idade a partir de 75 anos. Método: Estudo retrospectivo de série consecutiva de 100 pacientes dessa faixa etária, com hematoma subdural, operados em um período de oito anos, no Service de Neurochirurgie – Professeur Bernard Alliez do Hôpital Nord, AP-HM, Centre Hospitalier Universitaire de Marseille, França. Resultados: Os sintomas de alarme e o quadro clínico foram variados e enganadores, diferente do observado em pacientes mais jovens. Houve predominância masculina, a média etária foi de 82 anos; traumatismo craniano foi relatado em 42 casos; 96 pacientes foram operados, obtendo-se cura completa em 59 (61,4%); 22 (23%) ficaram com seqüelas neurológicas, e 15 (15,6%) faleceram. Conclusão: Apesar da idade avançada dos pacientes, a resposta ao tratamento cirúrgico foi boa com mais de 60% de cura completa. A idade avançada dos pacientes não deve ser considerada contra-indicação à cirurgia.

A chronic subdural hematoma is the collection of blood that slowly accumulates in the subdural space, and is a frequent clinical entity in neurosurgical practice. Worldwide, its prevalence is higher among the elderly population, and due to the proportion of people aged 65 years and older is expected to double by 2030, showing a substantial increase in its incidence. Its pathogenesis has been discussed in the literature for decades. The pathophysiology is increasingly clear due to recent findings on imaging studies and human models. Better understanding of the pathogenesis, identification of risk factors, progress in medical imaging and treatment has greatly improved the prognosis. We review the epidemiology, pathogenesis and pathophysiology, and thus offer an updated concept on the development of this condition commonly seen in hospitals. [ABSTRACT FROM AUTHOR]

A presença de paralisia do nervo oculomotor (NOM) sem outro déficit neurológico é considerada rara como forma de apresentação em hematoma subdural crônico (HSDC). Geralmente apresenta sintomas de déficit neurológico focal, cefaleia e alterações do nível de consciência, havendo múltiplos diagnósticos diferenciais. RTA, 79 anos, masculino. Paciente com demência senil, hipertensão arterial sistêmica e diabetes mellitus. Estado geral: moderado. Exame físico: sonolento, eupneico. Exame neurológico: disfásico e anisocoria esquerda. Tomografia computadorizada (TC) de crânio sem contraste revelou lesão com densidade heterogênea na região frontoparietotemporal esquerda com efeito de massa e hipodensa na região frontoparietal direita. Submetido a trépano-punção frontal anterior e parietal posterior esquerda e drenagem do hematoma. Evoluiu com melhora da paralisia do NOM à esquerda. Em caso de HSDC volumoso, pode-se comprimir o mesencéfalo e apresentar-se herniação do uncus do hipocampo, podendo causar paralisia do NOM. Seu diagnóstico precoce e tratamento correto apresentam bons resultados.

O objetivo deste estudo é analisar a evolução de pacientes com hematoma subdural crônico em relação aos achados do coagulograma. Foram analisados 161 pacientes operados no Hospital das Clínicas-UNICAMP entre abril de 1994 e 2000. Foi detectado um predomínio do sexo masculino (86,3%), da cor branca (85,1%) e da faixa etária na quinta década (mediana 57 anos). O estudo mostrou mortalidade maior no período pós-operatório entre os pacientes com valores de RNI (international normalized ratio) superiores a 1,25 e/ou trombocitopenia (p

Os autores apresentam 31 casos de hematoma subdural crônico, operados no período de janeiro de 1995 a outubro de 1999, nos quais a mortalidade e a morbidade cirúrgica foram nulas e atribuídas à técnica operatória utilizada, que se baseia em: 1) uso exclusivo de anestesia local; 2) orifício único de trepanação; 3) lavagem ostensiva da cavidade do hematoma; 4) drenagem aspirativa por 48 horas; e 5) decúbito lateral da cabeça para o lado da trepanação. Em dois casos o procedimento foi realizado bilateralmente devido à bilateralidade do processo, sendo, conseqüentemente, adotada alternância de decúbito.

Os autores relatam 35 casos com diagnóstico de hematoma subdural crônico, operados no período de janeiro-1988 a março-1995. A idade dos pacientes variou entre 19 e 80 anos. Foram eles agrupados retrospectivamente segundo a escala de Bender. Quanto ao tratamento cirúrgico, foram empregadas duas técnicas: craniotomia com membranectomia e dupla trepanação com instilação de solução salina na cavidade ocupada pelo hematoma. O índice de mortalidade entre os pacientes submetidos à craniotomia foi 16,6% e nos pacientes submetidos à trepanação foi nulo. Dentre os pacientes que faleceram, 80% encontravam-se em grau III ou IV na escala de Bender. O hematoma subdural crônico apresenta até os dias atuais alguns aspectos controversos, como quanto à sua fisiopatologia e ao tratamento cirúrgico adequado.Thirty five patients with chronic subdural hematoma were treated surgically between 1988 and 1995. The patients, aged 19 to 80 years, were graded retrospectively according to the Bender scale. The clots were removed via burr-holes with irrigation of the subdural space to ensure as complete an evacuation of subdural colletion, and craniotomy with membranectomy. The mortality rate was 16.6% with craniotomy and 0% with burr-hole. The patients who died, 80% were in grade III or IV. The pathogenesis and surgical treatment of chronic subdural hematoma has been controversial, and still remains obscure.

OBJECTIVE: To describe presentation clinical forms of chronic subdural hematoma in elderly persons. METHODS: A retrospective study was conducted at the Provincial Hospital of Quelimane (Mozambique) in a period of four years (June 2009 to June 2013) of all cases diagnosed as chronic subdural hematoma with axial CT scan. The variables studied were: sex, age, hematoma side, risk factors and presentation clinical forms. RESULTS: The study sample consisted of twelve patients with age between 60 and 82 years old. 58.3 % of cases have hematomas located in the left side. Most patients were male (75 %). Among the risk factors that preceded the disease head trauma was the most frequent (66.6 %). Alcoholism was detected in six patients (50 %) and oral anticoagulants treatment in five patients (41.6 %). Progressive headache was more frequent in chronic subdural hematomas clinical presentation (41.6 %). Less frequency was detected of mental confusion (25 %), motor deficit (16.6 %) and uncal herniation syndrome (16.6 %). CONCLUSIONS: The clinical presentations of chronic subdural hematoma can be variable. Recognition of classical forms and risk factors can influence in a positive way in early diagnosis of these patients. [ABSTRACT FROM AUTHOR]

Introducción: el hematoma subdural crónico (HSDC) es una enfermedad relativamente común en mayores de 60 años. Su presentación clínica clásica es un síndrome neurológico focal progresivo con síntomas y signos de hipertensión endocraneana, en un paciente que generalmente tiene antecedentes de traumatismo craneano (TEC) al menos dos o tres semanas previas a la consulta. Sin embargo, el HSDC puede presentarse bajo diferentes formas clínicas que dificultan su diagnóstico. Material y método: se analizan los aspectos clínicos de 63 pacientes portadores de HSDC que consultaron en el Hospital de Tacuarembó en un período de 59 meses. Resultados: los pacientes tenían entre 30 y 88 años, 73% eran hombres. En 67% de los pacientes había antecedente de TEC. La forma de presentación más frecuente fue un cuadro progresivo de déficit focal o hipertensión endocraneana. En dos casos el déficit fue brusco, simulando un ataque cerebrovascular. En tres pacientes el antecedente traumático no fue recogido y se planteó clínicamente un proceso expansivo tumoral. En 11 casos los síntomas iniciales fueron de la esfera neuropsíquica, simulando una "demencia". En 18 casos hubo depresión de vigilia, siendo brusca en cinco de ellos, lo que llevó al planteo de ataque cerebrovascular hemorrágico o isquémico. En seis pacientes el síntoma cardinal era la cefalea permanente sin otros síntomas o signos. Conclusiones: el HSDC puede presentarse con distintas "máscaras clínicas", simulando procesos expansivos tumorales, ataques cerebrovasculares hemorrágicos o isquémicos, ataques isquémicos transitorios o demencias. Se debe entonces tener un alto índice de sospecha de esta enfermedad frente a individuos mayores de 60 años con un cuadro progresivo y de instalación insidiosa aun en ausencia de traumatismo de cráneo.

Background: posoperative intracerebral hemorrhage after drainage of chronic subdural hematoma is a rarely reported complication, however, its incidence, according to different series may be underestimated. Case report: this report presents a 77 year old male patient who, after the drainage of bilateral chronic subdural hematomas developed an extensive hemorrhage in the thalami, basal ganglia, midbrain and ports, with extension into the ventricles and obstructive hydrocephalus. Conclusions: compression by extra-axial collection decreases cerebral blood flow on the affected hemisphere and alters its vascular self-adjustment. The rapid increase in cerebral blood flow in brain areas with altered vascular self-adjustment appears to be the precipitating mechanism of intracerebral hemorrhage after surgical evacuation of chronic subdural hematomas. [ABSTRACT FROM AUTHOR]

Introduction. In recent years, the literature has supported the use of drills for evacuation of hematoma closed a technique less invasive than craniotomy. Material and methods. They conducted a study in patients from Central Military Hospital operating room area during the period from January 1 to September 30, 2008, to which the procedures were performed drainage of chronic subdural hematoma. To determine the physical status classification was used by the American Association of Anesthesiologists (ASA), and the clinical condition grading scale used clinically Bender Results. Nineteen patients with diagnosis of a chronic subdural hematoma were captured for close drainage with local anesthesia and sedation with Dexmedetomidine, which were classified according to the Richmond Agitation- Sedation Scale. While one patient was very agitated, three patients agitated and the rest alert and calm. Fourteen patients were found in Bender's Scale grade 1 and five in grade 2. Previous written informed consent, a dose of dexmedetomidine a rate of 1.5 μg/kg, i.v. was administered with a total dose average of 105 μg/kg. At the end of administration, twelve patients reached moderate sedation and six deep sedation. During the surgery, eighteen patients reached a deep sedation that allowed the nerve block and the closed drainage of the hematoma. With a pressure average of 98 mmHg, heart rate 58 beats per minute, while the respiratory rate remained at an average of 14 and SaO2 in 99%. In one patient moderate sedation reached was maintained during nerve block, with the incision of the skin the patient around very agitated, was necessary to implement a bolus of fentanyl of 70 μg in addition of 1.5 mg of Midazolam, with which reached a deep sedation that allowed the surgical procedure. Conclusion. In an effort to reduce cases of failed sedation, improvement in the percentage of adverse events and reduce the time of recovery in patients undergoing drainage of chronic subdural hematoma, the use of dexmedetomidine a agonist α2 adrenergic highly selective which owns analgesic and sedatives effects, can be a good choice in the management of these patients. [ABSTRACT FROM AUTHOR]

Objective: To analyze the characteristics and results of cases with chronic subdural hematoma treated with osteoplastic craneotomy and radical parietal membranectomy. Methods: A descriptive study was carried out of cases with chronic subdural hematoma treated with osteoplastic craneotomy and radical parietal membranectomy between 2005-2010 years, in neurosurgery service of "Manuel Ascunce Domenech" Universitary Hospital of Camagüey. Results: Seven patients treated with osteoplastic craneotomy and radical parietal membranectomy represents 5% of total treated for chronic subdural hematoma in this period. In the majority of this patients is detected a hematoma recollection, arterial hypertension was a remarkable antecedent, somnolence or mental confusion, shift of middle structures and mix densities of hematoma in cranial CT scan. Conclusions: Osteoplastic craneotomy and radical parietal membranectomy is a surgical technique useful for the recidivate chronic subdural hematoma and first line option in cases with important calcification of capsule, acute hemorrhages in cavity or thick/tabicated membranes. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: A comprehension of the normal anatomy of meninges and intracraneal spaces is crucial for neurosurgeons, neurologists and neuroradiologists dealing with diagnosis and treatment of a wide range of pathologies of the central nervous system. Material and method: For example, the distribution of blood within the cranial spaces (extradural, subdural or subarachnoidal hemorrhages) is highly dependent on the normal or pathologic anatomy of the three meningeal sheaths. Discusion and conclusions: In this report, the authors made an actualized interpretation of intracranial spaces, based in a literature review and the study of blocks of brain and meninges and chronic subdural hematoma capsules obtained at surgery. [ABSTRACT FROM AUTHOR]