Search

By maximizing the advantages of exoscopy, we developed a keyhole approach for intracranial hematoma removal. Herein, we validated the utility of this procedure, and compared it with conventional microscopic hematoma removal and endoscopic hematoma removal in our institution. We included 12 consecutive patients who underwent this procedure from June 2022 to March 2024. A 4-cm-long skin incision was made, and a keyhole craniotomy (diameter, 2.5 cm) was performed. An assistant manipulated a spatula, and an operator performed hematoma removal and hemostasis using typical microsurgical techniques under an exoscope. The dura mater was reconstructed without sutures using collagen matrix and fibrin glue. The outcomes of this series were compared with those of 12 consecutive endoscopic hematoma removals and 19 consecutive conventional microscopic hematoma removals from October 2018 to March 2024. The mean age was 72 ± 10 years, and 7 (58%) patients were men. Hematoma location was the putamen in 5 patients and subcortical in 7 patients. The mean operative time was 122 ± 34 min, the mean hematoma removal rate was 95% ± 8%, and the mortality rate was 0%. Although the preoperative hematoma volume was similar between the 3 groups, the operative time and total time in the operating room was significantly shorter in the exoscope group than in the microscope group (P < 0.0001). This procedure may be simpler and faster than conventional microscopic hematoma removal, and comparable to endoscopic hematoma removal. [ABSTRACT FROM AUTHOR]

Background and objectives: This study aimed to assess the impact and predicted outcomes of patients with multiple trauma by identifying the prevalence of trauma sustained and associated complications. Materials and Methods: This retrospective cohort study focused on individual characteristics of patients with multiple trauma admitted to our County Emergency Hospital. The final table centralized the characteristics of 352 subjects aged between 3 and 93 years who presented with multiple trauma from 2015 to 2021. Inclusion criteria for this study were the presence of multiple trauma, intervention times, mentioned subjects' ages, and types of multiple trauma. Results: Patients with multiple trauma face an increased risk of mortality due to the underlying pathophysiological response. Factors that can influence the outcomes of multiple-trauma patients include the severity of the initial injury, the number of injuries sustained, and the location of injuries. Conclusion: The first 60 min after trauma, known as the "golden hour," is crucial in determining patient outcomes. Injuries to the head, neck, and spine are particularly serious and can result in life-threatening complications. [ABSTRACT FROM AUTHOR]

Spontaneous intracranial hypotension (SIH) is a potentially debilitating condition resulting from a low cerebrospinal fluid (CSF) volume secondary to spinal CSF leakage. Characteristic clinical and radiological imaging findings are helpful in diagnosis. Herein, we present and discuss the magnetic resonance imaging (MRI) and CSF flow study of two patients with SIH and no CSF flow within the cerebral aqueduct, which is extremely rare in the literature. [ABSTRACT FROM AUTHOR]

Spontaneous intracranial hemorrhage (ICH) patients are still at risk of postoperative ischemic complications (PICs) after surgery. In addition, the proportion of patients receiving antiplatelet therapy (APT) in ICH patients increased significantly with age. This study aims to evaluate the impact of preoperative antiplatelet therapy on PICs in ICH patients. This is a cohort study that retrospectively analyzed the data of ICH patients who underwent surgical treatment. PICs rate was compared between patients with preoperative ATP and those without preoperative ATP. Univariate and multivariate analyses were conducted to evaluate the impact of preoperative APT on PICs. In addition, Kaplan-Meier method was used for survival analysis and the impact of PICs on patients' postoperative outcomes was evaluated. A total of 216 patients were included in this study. There were 47 patients (21.76%) with preoperative APT; 169 patients (78.24%) without preoperative APT. The incidence of PICs in the APT group was significantly higher when compared with that in the nAPT group (36.17% vs. 20.71%, p = 0.028＜0.05). Furthermore, significant differences were both observed in multivariate analysis (p = 0.035＜0.05) and survival analysis (log rank χ2 = 5.415, p = 0.020＜0.05). However, there was no significant difference between the outcomes of patients suffering from PICs and that of patients not suffering from PICs (p = 0.377 > 0.05). In conclusion, preoperative APT may be a risk factor for PICs in ICH patients undergoing surgical treatment significantly. [ABSTRACT FROM AUTHOR]

Traumatic intracranial aneurysm (TICA) is a rare and aggressive pathology that requires prompt treatment. Nevertheless, early vascular imaging following head trauma may yield falsely negative results, underscoring the importance of subsequent imaging within the first week to detect delayed TICAs. This study aims to report our experience with delayed TICAs and highlight the clinical importance of repeated angiographic screening for delayed TICAs. In this retrospective analysis, we evaluated patients managed for a TICA at a tertiary care teaching institution over the last decade. Additionally, we conducted a systematic review of the literature, following the PRISMA guidelines, on previously reported TICAs, focusing on the time lag between the injury and diagnosis. Twelve delayed TICAs were diagnosed in 9 patients. The median time interval from injury to diagnosis was 2 days (IQR: 1–22 days), and from diagnosis to treatment was 2 days (IQR: 0–9 days). The average duration of radiological follow-up was 28 ± 38 months. At the final follow-up, four patients exhibited favorable neurological outcomes, while the remainder had adverse outcomes. The mortality rate was 22%. Literature reviews identified 112 patients with 114 TICAs, showcasing a median diagnostic delay post-injury of 15 days (IQR: 6–44 days), with 73% diagnosed beyond the first week post-injury. The median time until aneurysm rupture was 9 days (IQR: 3–24 days). Our findings demonstrate acceptable outcomes following TICA treatment and highlight the vital role of repeated vascular imaging after an initial negative computed tomography or digital subtraction angiography in excluding delayed TICAs. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to highlight presentations, acute findings and imaging phenotypes of patients presenting to the emergency department (ED) within 30 days of a transcatheter aortic valve replacement (TAVR). Methods: A retrospective review of patients diagnosed with aortic valve disease who underwent a TAVR between Jan 2015 and Nov 2021 at a large academic medical center was completed. From an initial 1271 patients, 146 were included based on their presentation to the ED within 30 days post-TAVR procedure. Patient data, including ED presentation details and imaging results, were recorded and de-identified. Results: Of the 146 post-TAVR patients, there were 168 ED visits within 30 days. The median time to ED after TAVR was 12 days. Respiratory symptoms were the most common complaint (27%). Neurological (23%) and cardiovascular symptoms (18%) followed. Cross-sectional imaging was conducted 250 times across visits, with an average of 1.7 scans per patient. CTs were most frequently used, followed by ultrasounds, especially echocardiograms and duplex extremity vasculature ultrasounds. 30.1% of patients had acute findings from imaging. Specific findings included heart failure (5.5%), access site complications (5.5%), pneumonia (5.5%), intracranial pathologies (3.4% for strokes and 0.7% for hematoma), and pleural effusion (3.4%). Echocardiograms and CTA chest were most associated with significant acute findings. Conclusion: Our study highlights the vital role of early and accurate imaging in post-TAVR patients within 30 days post-procedure. As transcatheter approaches rise in popularity, emergency radiologists become instrumental in diagnosing common post-procedural presentations. Continued research is essential to devise post-discharge strategies to curtail readmissions and related costs. Proper imaging ensures prompt, effective care, enhancing overall patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Hypertensive intracerebral hemorrhage is one of the most serious complications of hypertension. The treatment focuses on reducing bleeding damage and promoting functional recovery. Aim: This study investigated the efficacy and prognosis of endoscopic intracranial hematoma removal (EIHR) and hematoma puncture and drainage (HPD) in treating hypertensive intracerebral hemorrhage (HICH). Material and methods: Ninety-two patients admitted to our hospital for EIHR and HPD between September 30, 2021 and September 30, 2022 were enrolled, including 14 cases of EIHR (endoscopy group) and 78 cases of HPD (puncture group). The efficacy of the two surgery modes in treating HICH patients was compared. Univariate logistic regression (ULR) and multivariate logistic regression (MLR) were employed to analyze the influences of different treatment methods on the prognosis of patients with HICH. Results: The average hematoma clearance rate (HCR) of all patients was 80.52%, and the patients in the endoscopy group had a higher HCR than those in the puncture group (73.00% vs. 86.00%) (p < 0.001). The good prognosis rate (GPR) shown by the Glasgow Outcome Scale (GOS) score in the endoscopy group was 69.23%, and that in the puncture group was 40.38%, a large but statistically non-significant difference (p > 0.05). Conclusions: The HCR of EIHR was greatly higher based on that of HPD, but showed no great difference in prognostic effect. The higher the GCS score on admission, the lower the likelihood of poor prognosis. [ABSTRACT FROM AUTHOR]

Intracranial hemorrhage (ICH) is a severe condition that requires rapid diagnosis and treatment. Automated methods for calculating ICH volumes can reduce human error and improve clinical decisioPlease provide professional degrees (e.g., PhD, MD) for the corresponding author.n-making. A novel automated method has been developed that is comparable to the ABC/2 method in terms of speed and accuracy while providing more accurate volumetric data. We developed a novel automated algorithm for calculating intracranial blood volume from computed tomography (CT) scans. The algorithm consists of a Python script that processes Digital Imaging and Communications in Medicine images and determines the blood volume and ratio. The algorithm was validated against manual calculations performed by neurosurgeons. Our novel automated algorithm for calculating intracranial blood volume from CT scans demonstrated excellent agreement with the ABC/2 method, with a median overall difference of just 1.46 mL. The algorithm was also validated in patient groups with ICH, epidural hematoma (EDH), and SDH, with agreement coefficients of 0.992, 0.983, and 0.997, respectively. The study introduces a novel automated algorithm for calculating the volumes of various ICHs (EDH, and SDH) within CT scans. The algorithm showed excellent agreement with manual calculations and outperformed the commonly used ABC/2 method, which tends to overestimate ICH volume. The automated algorithm offers a more accurate, efficient, and time-saving approach to quantifying ICH, EDH, and SDH volumes, making it a valuable tool for clinical evaluation and decision-making. [Display omitted] [ABSTRACT FROM AUTHOR]

Spontaneous intracranial hypotension (SIH) is an important cause of daily headaches that occur in young and middle-aged, active persons and is often misdiagnosed, leading to prolonged inactivity and rather high healthcare expenditures. Its diagnosis requires a high degree of clinical suspicion and careful interpretation of imaging studies. We present a case of SIH, which was successfully treated but which posed serious diagnostic challenges, ranging from cerebro-vascular disease and meningitis to granulomatous diseases, and for whom every therapeutic attempt just worsened the patient's condition until we finally reached the correct diagnosis. To raise awareness of this condition, we also present an updated overview of the clinical picture, evaluation, and treatment options for SIH. [ABSTRACT FROM AUTHOR]

Introduction: One of the most serious complications associated with antiplatelet agents is antiplatelet‐associated intracranial hemorrhage (AA‐ICH). Desmopressin is a synthetic antidiuretic hormone (ADH) analog. It has been linked to improving patient outcomes in antiplatelet‐induced intracranial hemorrhage. The secondary outcomes included the incidence of thrombotic complications and neurological outcomes. Methods: A systematic search was conducted on three databases (PubMed, Cochrane, and ClinicalTrials.gov) to find eligible literature that compares desmopressin (DDAVP) versus controls in patients with AA‐ICH. The Mantel–Haenszel statistic was used to determine an overall effect estimate for each outcome by calculating the risk ratios and 95% confidence intervals (CI). Heterogeneity was measured using the I2 test. The risk of bias in studies was calculated using the New Castle Ottowa Scale. Results: Five studies were included in the analysis with a total of 598 patients. DDAVP was associated with a nonsignificant decrease in the risk of hematoma expansion (RR =.8, 95% CI,.51–1.24; p =.31, I2 = 44%). It was also associated with a non‐significant decrease in the risk of thrombotic events (RR,.83; 95% CI,.25–2.76; p =.76, I2 = 30%). However, patients in the DDAVP group demonstrated a significant increase in the risk of poor neurological outcomes (RR, 1.31; 95% CI, 1.07–1.61; p =.01, I2 = 0%). The risk of bias assessment showed a moderate to low level of risk. Conclusion: DDAVP was associated with a nonsignificant decrease in hematoma expansion and thrombotic events. However, it was also associated with a significantly poor neurological outcome in the patients. Thus, until more robust clinical trials are conducted, the use of DDAVP should be considered on a case‐to‐case basis. [ABSTRACT FROM AUTHOR]

Objective:To systematically evaluate the efficacy and safety of minimally invasive removal of intracranial hematoma combined with Naoxueshu treatment for spontaneous cerebral hemorrhage. Methods:Computer search was conducted on Chinese and English databases including CNKI, VIP, Wanfang, CBM, PubMed, Embase and the Cochrane Library from the establishment of the database to June 2023, based on inclusion and exclusion criteria to select randomized controlled trials (RCTS) of minimally invasive removal of intracranial hematoma combined with Naoxueshu oral liquid in the treatment of spontaneous intracerebral hemorrhage. The risk of bias was evaluated according to the Cochrane Systematic Review Manual, and meta-analysis was performed using Revman5.4 software, and the GRADE system was used to evaluate the evidence quality of outcome indicators. Results:Totally 9 RCTs were included, and the total sample size was 739 cases. There were 371 cases in the control group and 368 cases in the experimental group. The results of meta-analysis showed that compared with only conventional Western medicine after minimally invasive surgery, combined application of Naoxueshu oral liquid improved the overall clinical effectiveness rate [OR=5.47, 95%CI=2.28, 13.09, P=0.000 1], obviously reduced the score of National Institute of Health Stroke Scale [MD=-3.42, 95%CI=-4.97, -1.87, P<0.000 1], and neurological impairment score Chinese stroke patients [MD=-2.30, 95%CI=-3.01, -1.58, P<0.000 01], improved Glasgow Coma Scale score [MD=1.51, 95%CI=1.13, 1.89, P<0.000 01] and Barthel Index (BI) score [MD=6.88, 95%CI=4.49, 9.27, P<0.000 01], and decreased serum S100 protein [MD=-0.02, 95%CI=-0.03, -0.02, P<0.000 01] and AQP4 levels [MD=-0.02, 95%CI=-0.03, -0.01, P=0.002[. In terms of safety, no serious adverse reactions were reported;gastrointestinal discomfort symptoms including nausea, abdominal distension and diarrhea were reported in 2 studies; no adverse reactions were reported in the remaining studies. Conclusion:Existing evidence shows that minimally invasive removal of intracranial hematoma combined with Naoxueshu oral liquid in the treatment of spontaneous cerebral hemorrhage has obvious effects in reducing the degree of neurological impairment and consciousness disorder, improving patients' daily living ability, ameliorating patients' quality of life and other aspects, and has certain safety. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Veterinary Journal / Revue Vétérinaire Canadienne is the property of Canadian Veterinary Medical Association 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.)

We aim to develop machine learning (ML) models for predicting the complexity and mortality of polytrauma patients using clinical features, including physician diagnoses and physiological data. We conducted a retrospective analysis of a cohort comprising 756 polytrauma patients admitted to the intensive care unit (ICU) at Pizhou People's Hospital Trauma Center, Jiangsu, China between 2020 and 2022. Clinical parameters encompassed demographics, vital signs, laboratory values, clinical scores and physician diagnoses. The two primary outcomes considered were mortality and complexity. We developed ML models to predict polytrauma mortality or complexity using four ML algorithms, including Support Vector Machine (SVM), Random Forest (RF), Artificial Neural Network (ANN) and eXtreme Gradient Boosting (XGBoost). We assessed the models' performance and compared the optimal ML model against three existing trauma evaluation scores, including Injury Severity Score (ISS), Trauma Index (TI) and Glasgow Coma Scale (GCS). In addition, we identified several important clinical predictors that made contributions to the prognostic models. The XGBoost-based polytrauma mortality prediction model demonstrated a predictive ability with an accuracy of 90% and an F-score of 88%, outperforming SVM, RF and ANN models. In comparison to conventional scoring systems, the XGBoost model had substantial improvements in predicting the mortality of polytrauma patients. External validation yielded strong stability and generalization with an accuracy of up to 91% and an AUC of 82%. To predict polytrauma complexity, the XGBoost model maintained its performance over other models and scoring systems with good calibration and discrimination abilities. Feature importance analysis highlighted several clinical predictors of polytrauma complexity and mortality, such as Intracranial hematoma (ICH). Leveraging ML algorithms in polytrauma care can enhance the prognostic estimation of polytrauma patients. This approach may have potential value in the management of polytrauma patients. [ABSTRACT FROM AUTHOR]

Early operative intervention, craniotomy, and/or craniectomy are occasionally warranted in severe traumatic brain injury (TBI). Persistent increased intracranial pressure or accumulation of intracranial hematoma postsurgery can result in higher mortality and morbidity. There is a gap in information regarding the outcome of repeat surgery (RS) in pediatric patients with severe TBI. An observational cohort study titled Approaches and Decisions in Acute Pediatric TBI Trial data was obtained from the Federal Interagency Traumatic Brain Injury Research Informatics System. All pediatric patients who underwent craniotomy or decompressive craniectomy, survived more than 44 hours and were found to have persistent elevated intracranial pressure >20 mmHg for 2 consecutive hours were included in the study. The purpose of the study was to find the outcomes of RS in pediatric severe TBI. Propensity based matching was used to find the outcomes. The primary outcome was 60-day mortality. Out of 1000 total patients enrolled in the Approaches and Decisions in Acute Pediatric Trial, 160 patients qualified for this study. Propensity score matching created 13 pairs of patients. There were no significant differences found between the groups who had RS versus those who did not have repeat surgery on baseline characteristics. There were no significant differences found between the groups regarding 60-day mortality, median hospital days, median intensive care unit days, and 6-month favorable outcome on Glasgow Outcome Scale Extended score. There was no difference in mortality between patients who underwent a second surgery and patients who did not have to undergo a second surgery. [ABSTRACT FROM AUTHOR]

Background and Objectives: In recent years, electronic scooters (e-scooters) have gained popularity, whether for private use or as a publicly available transportation method. With the introduction of these vehicles, reports of e-scooter-related accidents have surged, sparking public debate and concern. The aim of this study was to analyze the epidemiological data, characteristics, and severity of traumatic brain injury (TBI) related to e-scooter accidents. Materials and Methods: This retrospective case series evaluated patients who were admitted to the three largest neurosurgery clinics in Riga, Latvia, from the time period of April to October in two separate years—2022 and 2023—after e-scooter-related accidents. The data were collected on patient demographics, the time of the accident, alcohol consumption, helmet use, the type of TBI, other related injuries, and the treatment and assessment at discharge. Results: A total of 28 patients were admitted with TBI related to e-scooter use, with a median age of 30 years (Q1–Q3, 20.25–37.25), four individuals under the age of 18, and the majority (64%) being male. In 23 cases, the injury mechanism was falling, in 5 cases, collision. None were wearing a helmet at the time of the injury. Alcohol intoxication was evident in over half of the patients (51.5%), with severe intoxication (>1.2 g/L) in 75% of cases among them. Neurological symptoms upon admission were noted in 50% of cases. All patients had intracranial trauma: 50% had brain contusions, 43% traumatic subdural hematoma, and almost 30% epidural hematoma. Craniofacial fractures were evident in 71% of cases, and there were fractures in other parts of body in three patients. Six patients required emergency neurosurgical intervention. Neurological complications were noted in two patients; one patient died. Conclusions: e-scooter-related accidents result in a significant number of brain and other associated injuries, with notable frequency linked to alcohol influence and a lack of helmet use. Prevention campaigns to raise the awareness of potential risks and the implementation of more strict regulations should be conducted. [ABSTRACT FROM AUTHOR]

Case Presentation: We present a case of a 10-year-old male who developed an atraumatic, nasal septal hematoma with abscess following several days of rhinorrhea and cough. His chief complaint to the emergency department was a two-day history of nasal swelling and discomfort, associated with difficulty breathing through his nose. The patient was well-appearing with swelling and tenderness along the external nasal ridge and nasal septal swelling that occluded both nares. Contrast-enhanced maxillofacial computed tomography revealed a rim-enhancing, fluid-filled collection to the anterior nasal septum. The patient underwent successful incision and drainage by otolaryngology. Discussion: Infected septal hematomas are rare but important to recognize as they can result in septal deformity and potentially life-threatening sequelae, such as intracranial infections. Most are secondary to nasal trauma in adult patients. This case highlights a unique presentation of atraumatic septal hematoma with abscess formation in an immunocompetent pediatric patient. [ABSTRACT FROM AUTHOR]

Abstract Introduction Intracranial hematoma is the collection of blood in various intracranial spaces. Knowledge of patterns, origins, causes and outcomes of ICH conditions is important for decision-making for urgent surgical interventions such as craniotomy and hematoma evacuations. No prior study was conducted in our setup. Hence, this study aimed to assess the patterns and management outcomes of intracranial hematomas in low-resource setting and tailored our management approach at Jimma University Medical center. Methods An institution-based prospective observational study was conducted at Jimma University Medical Center, Ethiopia, for six consecutive months from June to December 2020. Different data sources and interview methods were used and analyzed using SPSS version 24. A bivariate and multivariate logistic regression was conducted to determine the association between the variables. Results A total of 91 eligible patients were recruited during the study period, with a mean age of 34 years. The majority of patients were males [73 (80.2%)] and more common in reproductive age groups (62.6%), from rural areas (50.5%). About 93.4% of patients reported a history of trauma, and road traffic accidents & fighting account for 63.8% of the trauma cases. Sixty-five percent of patients arrive in the hospital within 24 h. Upon presentation, there were loss of consciousness (48.4%), convulsion (11%), aspiration (9.9%) and increased ICP (12%). The majority (49.5%) of the patients had a mild head injury. The focal neurologic deficits were hemiparesis (29.7%) and hemiplegia (5.5%). Acute epidural hematoma (68.1%) was a common finding, followed by sub-acute subdural hematoma. Of the total study participants, 11% had died. All the surviving patients were accessed at 30 days after discharge and re-assessed, 66 patients had good neurologic recovery (62 upper and 4 lower good recovery), 11 patients had moderate disability (7 lower and 4 upper-moderate disabilities), two patients had a severe disability, and two patients (among those with severe disability) had died. Conclusion Trauma was invariably the cause of intracranial hematoma, and patients with low GCS, papillary abnormalities, aspiration and increased ICP had an increased risk of dying from their illness. It is good to formulate policies to enhance injury prevention and bring about health-oriented behavioral change.

Background: To review the treatment and the causes of postoperative epidural hematoma (PEDH) after intracranial tumor resection. Method: A retrospective case study was conducted to examine a series of patients who developed PEDH as a complication following intracranial tumor resection between January 2016 and June 2021. The study collected data from hospital charts, including clinical status at admission, imaging results, histopathologic findings, surgical management, complications, and outcomes. Causes of PEDH were evaluated through a review of operative notes and discussions with the surgical team. Results: Twenty-five patients (10 males, 15 females; median age 42 years, range 11–61 years; median medical history 27 months, range 1–96 months) were enrolled in the study. Regarding tumor location, 16 cases exhibited supratentorial brain tumors, 4 cases had infratentorial brain tumors, 2 cases of tumors occurred in the petroclival region, 2 cases in the peritorcular region, and 1 case in the pineal region. Four of these cases were complicated with supratentorial hydrocephalus. The 25 cases in this study were classified into four types based on location. Type 1 refers to EDHs that occur at the adjacent site of the operative field without involvement of the surgical area. Type 2 includes hematomas that occur at the adjacent site of the surgical area and the surgical area. Type 3 includes EDHs that occur in distant areas, and type 4 involves EDHs in the surgical field. The numbers of cases of types 1, 2, 3, and 4 PEDHs were 16, 2, 3, and 4 cases, respectively. Most PEDHs were associated with reduced ICP after craniotomy due to intracranial tumor resection and substantial loss of CSF. All patients achieved satisfactory outcomes after hematoma evacuation. Conclusion: The decrease in ICP resulting from intracranial tumor resection and CSF loss might lead to PEDHs. By employing optimized surgical techniques and meticulous patient management to prevent rapid decreases in ICP and dural detachment, we can potentially lower the incidence of PEDHs. Additionally, prompt evacuation of hematomas can contribute to positive outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Intracranial hematoma is the collection of blood in various intracranial spaces. Knowledge of patterns, origins, causes and outcomes of ICH conditions is important for decision-making for urgent surgical interventions such as craniotomy and hematoma evacuations. No prior study was conducted in our setup. Hence, this study aimed to assess the patterns and management outcomes of intracranial hematomas in low-resource setting and tailored our management approach at Jimma University Medical center. Methods: An institution-based prospective observational study was conducted at Jimma University Medical Center, Ethiopia, for six consecutive months from June to December 2020. Different data sources and interview methods were used and analyzed using SPSS version 24. A bivariate and multivariate logistic regression was conducted to determine the association between the variables. Results: A total of 91 eligible patients were recruited during the study period, with a mean age of 34 years. The majority of patients were males [73 (80.2%)] and more common in reproductive age groups (62.6%), from rural areas (50.5%). About 93.4% of patients reported a history of trauma, and road traffic accidents & fighting account for 63.8% of the trauma cases. Sixty-five percent of patients arrive in the hospital within 24 h. Upon presentation, there were loss of consciousness (48.4%), convulsion (11%), aspiration (9.9%) and increased ICP (12%). The majority (49.5%) of the patients had a mild head injury. The focal neurologic deficits were hemiparesis (29.7%) and hemiplegia (5.5%). Acute epidural hematoma (68.1%) was a common finding, followed by sub-acute subdural hematoma. Of the total study participants, 11% had died. All the surviving patients were accessed at 30 days after discharge and re-assessed, 66 patients had good neurologic recovery (62 upper and 4 lower good recovery), 11 patients had moderate disability (7 lower and 4 upper-moderate disabilities), two patients had a severe disability, and two patients (among those with severe disability) had died. Conclusion: Trauma was invariably the cause of intracranial hematoma, and patients with low GCS, papillary abnormalities, aspiration and increased ICP had an increased risk of dying from their illness. It is good to formulate policies to enhance injury prevention and bring about health-oriented behavioral change. [ABSTRACT FROM AUTHOR]

In resource-limited settings, the standard of care prescribed in developed countries for either operative or nonoperative management of traumatic intracranial hematomas (TICHs) frequently has to be adapted to the economic and infrastructural realities. This study aims to present the outcome of selected cases of TICHs managed nonoperatively without routine intensive care unit admission, repeated cranial computed tomography (CT) scan or intracranial pressure monitoring at a rural neurosurgical service in a developing country. This was a retrospective analysis of a cohort of our patients with cranial CT-confirmed TICHs selected for nonoperative treatment from our prospective head injury (HI) register over a 42-month period. There were 67 patients (51 males) in this study with a mean age of 38.6 (standard deviation, 17.6) years, having mild HI in >half, (55.2%, 37/67) and anisocoria in 22.4% (15/67). Road traffic accident was the most common (50/67, 74.7%) trauma etiology. Isolated acute-subdural hematoma, intracerebral hemorrhage, and epidural hematoma occurred in 29.9%, 25.4%, and 22.4% of the patients respectively. Only 2 of 8 patients in whom intensive care unit admission was deemed necessary could afford admission. Repeat cranial CT scan was requested in 8 patients (8/67, 11.9%); only 5 of these could afford the investigation. The outcome of care was good in 82.1% patients (55/67). Increasing severity of the HI (P < 0.01) and presence of pupillary abnormality (P = 0.03) were significant predictors of poor outcome. In a Nigerian rural neurosurgery practice, nonoperative management of a well-selected cohort of TICHs was attended by acceptable level of favorable outcome. [ABSTRACT FROM AUTHOR]

A retrospective analysis of surgical treatment data was carried out in 120 patients with severe combined cranio-abdominal trauma, including 86 men (71.7%) and 34 women (28.3%) (average age 37.5 ± 5.90 years), delivered to the clinic within 2 hours from the moment of injury in the period 2019-2022. The most frequent combinations of injuries were abdominal and head injury (62.3%), abdominal and limb injury (58.7%), chest and abdominal injury (57.1%). On average, there were 1.62 ± 0.03 injuries to the abdominal cavity and retroperitoneal space per patient. Laparoscopy was the final method of diagnosis and treatment of abdominal injuries in 86 patients (71.7%). [ABSTRACT FROM AUTHOR]

Objectives: Traumatic intracranial hematomas represent a critical clinical situation where early detection and management are of utmost importance. Machine learning has been recently used in the detection of neuroradiological findings. Hence, it can be used in the detection of intracranial hematomas and furtherly initiate a management cascade of patient transfer, diagnostics, admission, and emergency intervention. We aim, here, to develop a diagnostic tool based on artificial intelligence to detect hematomas instantaneously, and automatically start a cascade of actions that support the management protocol depending on the early diagnosis. Materials and Methods: A plot was designed as a staged model: The first stage of initiating and training the machine with the provisional evaluation of its accuracy and the second stage of supervised use in a tertiary care hospital and a third stage of its generalization in primary and secondary care hospitals. Two datasets were used: CQ500, a public dataset, and our dataset collected retrospectively from our tertiary hospital. Results: A mean dice score of 0.83 was achieved on the validation set of CQ500. Moreover, the detection of intracranial hemorrhage was successful in 94% of cases for the CQ500 test set and 93% for our local institute cases. Poor detection was present in only 6-7% of the total test set. Moderate false-positive results were encountered in 18% and major false positives reached 5% for the total test set. Conclusion: The proposed approach for the early detection of acute intracranial hematomas provides a reliable outset for generating an automatically initiated management cascade in high-flow hospitals. [ABSTRACT FROM AUTHOR]

Modern classification of traumatic brain injury with identification of clinical and morphological variants is provided. Neurological semiotics and neuroimaging diagnosis of concussion, mild, moderate and severe cerebral contusion, compression of the brain with epidural, subdural and intracerebral hematomas are described based on the analysis of observations of the National Medical Research Center for Neurosurgery named after Academician N.N. Burdenko.

Chronic subdural hematoma (CSH) in the posterior fossa is extremely rare in the adult population. CT scanning is generally accurate and sufficiently sensitive in the diagnosis of supratentorial subdural hematomas, while MRI has clearly shown its superiority in the detection of subdural collections at unusual locations and particularly in the detailed analysis of the posterior cranial fossa. The surgical strategy is still controversial. We report a case of CSH in the posterior fossa successfully treated with a suboccipital craniectomy. A 70-year-old man; has developed headaches, nausea, cerebellar syndrome and ataxia of walking. Radiological examinations revealed the appearance of a right CSH in the posterior fossa associated with hydrocephalus. Upon rapid deterioration of the patient's consciousness, urgent treatment was required. A small right suboccipital craniectomy was to access the hematoma. Postoperative computed tomography showed that the CSH and hydrocephalus had been successfully treated. [ABSTRACT FROM AUTHOR]

Cardiac complications are related to poor prognosis after spontaneous intracerebral hemorrhage (ICH). This study aims to predict the cardiac complications arising from small intracranial hematoma at ultraearly stage. The data of this work were derived from the Risk Stratification and Minimally Invasive Surgery in Acute ICH Patients study (ClinicalTrials.gov Identifier: NCT03862729). This work included patients with ICH but without brain herniation, as confirmed by a brain computed tomography scan within 48 hours of symptom onset. Every Patient's information recorded at the emergent department, including clinical, laboratory, electrocardiogram, and medical records, was derived from the electronic data capture. Cardiac complications were defined as the occurrence of myocardial damage, arrhythmias, and ischemic electrocardiogram changes during hospitalization. Variables associated with cardiac complications were filtrated by univariate and multivariate regression analyses. Independent risk factors were used to form the early predictive model. The restricted cubic splines were employed to investigate the nonlinear associations in a more sophisticated and scholarly manner. A total of 587 ICH patients were enrolled in this work, including 72 patients who suffered from cardiac complications after ICH. Out of the 78 variables, 24 were found to be statistically significant in the univariate logistic regression analysis. These significant variables were then subjected to multivariate logistic regression analysis and utilized for constructing risk models. Multivariate logistic regression analysis showed high plasma fibrinogen (FIB) level [odds ratio (OR) per standard deviation (SD) 1.327, 95% confidence intervals (CI) 1.037–1.697; P = 0. 024)] and older age (OR per SD 1.777, 95% CI 1.344–2.349; P ＜0.001) were associated with a higher incidence of cardiac complications after ICH. High admission pulse rate (OR 0.620, 95% CI 0.451–0.853; P = 0. 003) was considered a protective factor for cardiac complications after ICH. In the restricted cubic spline regression model, FIB and cardiac complications following ICH were positively correlated and almost linearly (P for nonlinearity = 0.073). The reference point for FIB in predicting cardiac complications after ICH was 2.64 g/L. Emergent factors, including plasma FIB level, age, and pulse rate, might be independently associated with cardiac complications after ICH, which warrants attention in the context of treatment. [ABSTRACT FROM AUTHOR]

Background: Percutaneous balloon compression is a safe and effective treatment for trigeminal neuralgia. Current technique consists of penetrating the foramen ovale using a sharp 14G needle with a stylet. Difficulty of cannulation of the foramen ovale, failures of cannulation and major neurovascular complications of the procedure, although rare, may be due to the relatively large caliber of this needle and its sharp tip. Objective: To present a novel technique to facilitate and make the cannulation of the foramen ovale with a 14G cannula safer. Methods: A rigid blunt-tip guide of 1.2 or 1.5 mm is used to penetrate the foramen ovale under lateral fluoroscopic control. Once the guide enters the foramen it is advanced further to the clival line, and a 14G cannula is then advanced over the guide to engage the foramen, at which point the guide is withdrawn and replaced with the balloon catheter. Results: The technique was employed to deliver a 4F balloon catheter to Meckel's cave successfully in 500 consecutive procedures performed on 416 trigeminal neuralgia patients. None of the patients had neurovascular complications like facial hematoma, arterial injury, carotid-cavernous fistula or cranial nerve palsies. Conclusion: A novel technique for cannulation of the foramen ovale is described. The use of blunt tip guides of smaller diameters instead of sharp 14G needles considerably facilitated cannulation of the foramen ovale and enabled cannulation in all cases. Absence of complications of cannulation such as facial hematoma, carotid-cavernous fistula or intracranial hemorrhage in this series of patients suggests that the technique may be safer than the use of conventional sharp tipped 14G needles in terms of avoiding neurovascular complications. [ABSTRACT FROM AUTHOR]

Epidural hematoma (EDH) is found in 1-4% of traumatic brain injury cases. Acute triple extradural hematoma is a rare presentation of head trauma injury. In sporadic cases, they represent 0.5-1% of all extradural hematomas. Here is a case report of a 36-year-old female patient who presented to us with a head injury due to fall from a bike due to collision with a stray animal. The patient had a Glasgow Coma Scale of 9 (E2V2M5) with bilateral sluggishly reacting pupil to light. Computed tomography showed asymmetric bilateral posterior fossa EDHs along with an extradural hematoma in the right frontal region with multiple small contusions with mass effect. The surgical evacuation was performed first of the posterior fossa in the prone position and then right frontal hematoma evacuation in the supine position in the same sitting. The patient recovered well and was discharged on the 10th post-operative day with no neurological deficit. Early drainage of hematomas has been demonstrated to be an effective technique that soon decreases the intracranial pressure and promotes an efficient resolution to the neurological damage. [ABSTRACT FROM AUTHOR]

Cerebral ventriculitis is a life-threatening condition that requires prompt and effective pharmacological intervention. The continuous irrigation of the cerebral ventricles with fluid and its drainage is a system to remove toxic substances and infectious residues in the ventricles; this system is called IRRAflow®. We used this kind of ventricular irrigation/drainage system to treat two patients with post-surgical cerebral ventriculitis and a patient with bacterial meningitis complicated with ventriculitis. In this case series, we discuss the management of these three cases of cerebral ventriculitis: we monitored cytochemical parameters and cultures of the cerebrospinal fluid of patients during their ICU stay and we observed a marked improvement after irrigation and drainage with IRRAflow® system. Irrigation/drainage catheter stay, mode settings, and antibiotic therapies were different among these three patients, and neurological outcomes were variable, according to their underlying pathologies. IRRAflow® system can be applied also in other types of brain injury, such as intraventricular hemorrhage, intracranial abscess, subdural hematomas, and intracerebral hemorrhage, with the aim to remove the hematic residues and enhance the functional recovery of the patients. IRRAflow® seems a promising and useful tool to treat infectious and hemorrhagic diseases in neuro-intensive care unit. [ABSTRACT FROM AUTHOR]

Background Various high-energy tasks in the construction industry can lead to craniocerebral injuries. Construction industry–associated penetrating craniocerebral injuries due to metal foreign bodies have unique characteristics. However, no norms exist for removing metal foreign bodies and preventing secondary trauma. This study aimed to explore the characteristics and treatment of construction industry–associated penetrating craniocerebral injuries due to metal foreign bodies. Methods Data of patients who suffered from penetrating injuries due to metal foreign bodies and were treated in the Zhongshan People's Hospital from 2001 to 2021 were collected based on the causes of injuries to explore disease characteristics and therapeutic effects. Results A total of six patients with penetrating craniocerebral injuries due to metal foreign bodies, who underwent surgeries, were included in the study. Five patients recovered well after the surgery, and one patient died. In four patients, intracranial infection complicated the course after surgery, and two patients had delayed intracranial hematoma. Conclusion Patients with construction industry–associated penetrating craniocerebral injuries due to metal foreign bodies are prone to coma and intracranial vascular injuries. Early surgical removal and prevention of intracranial infection are key to achieving good therapeutic effects. [ABSTRACT FROM AUTHOR]

Objective To summarize the cases of hematoma in remote site after infratentorial craniotomy for tumors, and to explore the early identification methods as well as prevention and treatment strategies. Methods The clinical data of patients who underwent infratentorial craniotomy for tumors from Dec 2019 to Nov 2021 in the skull base subspecialty group of the department of neurosurgery, Huashan Hospital, Fudan University were retrospectively analyzed to summarize the location and type of hematoma in remote sites and its causes，and to explore its early identification methods and prevention strategies. Results Among the 490 patients who underwent infratentorial craniotomy for tumors，18 patients （3.67%） developed hematoma in remote site, including 9 cases with supratentorial subdural hematoma，3 cases with occipital epidural hematoma，2 cases with supratentorial subdural hematoma combined with interhemispheric subdural hematoma，2 cases with intraventricular hematoma，1 cases with interhemispheric subdural hematoma, and 1 patient temporal lobe intracerebral hematoma combined with subarachnoid hemorrhage. Two cases were accurately identified during operation, and the operation was terminated. Intraoperative head CT was performed to determine the type of hematoma, and surgical treatment was performed. All the other 16 cases were identified in the early postoperative period, and head CT was performed to identify the type of hematoma. One patient was treated with surgery and 15 cases were treated conservatively. All the 18 cases were followed up for 2-21 months after operation, and there was no death case. Conclusion The hematoma in remote site after infratentorial craniotomy for tumors is a rare and serious threat to the safety of surgery, mostly manifested as supratentorial subdural hematoma, epidural hematoma, intraventricular hematoma, interhemispheric subdural hematoma and intracerebral hematoma, which can be associated with subarachnoid hemorrhage. Perioperative active prevention, early and accurate identification as well as timely and effective treatment can significantly improve the prognosis of patients. [ABSTRACT FROM AUTHOR]

Objective: To date, there is no consensus on the surgery strategies of cranioplasty (CP) and ventriculoperitoneal shunt (VPS) placement. This meta‐analysis aimed to investigate the safety of staged and simultaneous operation in patients with comorbid cranial defects with hydrocephalus to inform future surgery protocols. Methods: A meta‐analysis of PubMed, Ovid, Web of Science, and Cochrane Library databases from the inception dates to February 8, 2023 adherent to PRISMA guidelines was conducted. The pooled analyses were conducted using RevMan 5.3 software. The outcomes included postoperative infection, reoperation, shunt obstruction, hematoma, and subdural effusion. Results: Of the 956 studies initially retrieved, 10 articles encompassing 515 patients were included. Among the total patients, 193 (37.48%) and 322 (62.52%), respectively, underwent simultaneous and staged surgeries. The finding of pooled analysis indicated that staged surgery was associated with lower rate of subdural effusion (14% in the simultaneous groups vs. 5.4% in the staged groups; OR = 2.39, 95% CI: 1.04–5.49, p = 0.04). However, there were no significant differences in overall infection (OR = 1.92, 95% CI: 0.74–4.97, p = 0.18), central nervous system infection (OR = 1.50, 95% CI: 0.68–3.31, p = 0.31), cranioplasty infection (OR = 1.58, 95% CI: 0.50–5.00, p = 0.44), shunt infection (OR = 1.30, 95% CI: 0.38–4.52, p = 0.67), reoperation (OR = 1.51, 95% CI: 0.38–6.00, p = 0.55), shunt obstruction (OR = 0.73, 95% CI: 0.25–2.16, p = 0.57), epidural hematoma (OR = 2.20, 95% CI: 0.62–7.86, p = 0.22), subdural hematoma (OR = 1.20, 95% CI: 0.10–14.19, p = 0.88), and intracranial hematoma (OR = 1.31, 95% CI: 0.42–4.07, p = 0.64). Moreover, subgroup analysis failed to yield new insights. Conclusions: Staged surgery is associated with a lower rate of postoperative subdural effusion. However, from the evidence of sensitivity analysis, this result is not stable. Therefore, our conclusion should be viewed with caution, and neurosurgeons in practice should make individualized decisions based on each patient's condition and cerebrospinal fluid tap test. [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.)

Ossified intracranial meningiomas (OIM) and ossified spinal meningiomas (OSM) are rare neoplasms of mesenchymal origin that predominantly manifest in the spinal cord and infrequently in the cranial region, accounting for -0. 7-5.5% of all meningiomas. It is extremely rare to have multiple intracranial and spinal lesions accompanied by ossification. Herein, we report this rare case for the first time. A 34-year-old woman presented with paresthesia and limb weakness in the right lower limb and gradually worsened. Approximately half a year later, she could only walk with crutches. Magnetic resonance imaging of the brain and spinal cord showed multiple meningiomas, and histopathological examination confirmed multiple OIM and OSM (WHO grade 1). Multiple OIM and OSM are extremely rare with diverse imaging features, and it is easily confused with other tumors. Histopathological examination is the final diagnostic method. [ABSTRACT FROM AUTHOR]

Background: Expansive intracranial hematomas (EIH) following traumatic brain injury (TBI) continue to be a public health problem in Uganda. Data is limited regarding the neurosurgical outcomes of TBI patients. This study investigated the neurosurgical outcomes and associated risk factors of EIH among TBI patients at Mulago National Referral Hospital (MNRH). Methods: A total of 324 subjects were enrolled using a prospective cohort study. Socio-demographic, risk factors and complications were collected using a study questionnaire. Study participants were followed up for 180 days. Univariate, multivariable, Cox regression analyses, Kaplan Meir survival curves, and log rank tests were sequentially conducted. P-values of < 0.05 at 95% Confidence interval (CI) were considered to be statistically significant. Results: Of the 324 patients with intracranial hematomas, 80.6% were male. The mean age of the study participants was 37.5 ± 17.4 years. Prevalence of EIH was 59.3% (0.59 (95% CI: 0.54 to 0.65)). Participants who were aged 39 years and above; PR = 1.54 (95% CI: 1.20 to 1.97; P = 0.001), and those who smoke PR = 1.21 (95% CI: 1.00 to 1.47; P = 0.048), and presence of swirl sign PR = 2.26 (95% CI: 1.29 to 3.95; P = 0.004) were found to be at higher risk for EIH. Kaplan Meier survival curve indicated that mortality at the 16-month follow-up was 53.4% (95% CI: 28.1 to 85.0). Multivariate Cox regression indicated that the predictors of mortality were old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having GOS < 3, QoLIBRI < 50, SDH, contusion, and EIH. Conclusion: EIH is common in Uganda following RTA with an occurrence of 59.3% and a 16-month higher mortality rate. An increased age above 39 years, smoking, having severe systemic disease, and the presence of swirl sign are independent risk factors. Old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having a GOS < 3, QoLIBRI < 50, ASDH, and contusion are predictors of mortality. These findings imply that all patients with intracranial hematomas (IH) need to be monitored closely and a repeat CT scan to be done within a specific period following their initial CT scan. We recommend the development of a protocol for specific surgical and medical interventions that can be implemented for patients at moderate and severe risk for EIH. [ABSTRACT FROM AUTHOR]

Background: Hypertensive intracerebral hemorrhage combined with cerebral hernia (HIH-CH) is a serious condition. Neuroendoscopy can effectively remove intracranial hematoma, but there is no relevant research support for its utility in patients with HIH-CH. The purpose of this study is to investigate the efficacy and safety of neuroendoscopy in patients with HIH-CH. Methods: Patients with HIH-CH who received craniotomy or neuroendoscopy treatment were included. The patients were divided into craniotomy (CHE) group and neuroendoscopy (NEHE) group. Clinical data and follow-up outcome of the two groups were collected. The primary outcome was hematoma clearance. Results: The hematoma clearance rate (%) of patients in NEHE group was 97.65 (92.75, 100.00), and that of patients in CHE group was 95.00 (90.00, 100.00), p >"0.05. The operation time and intraoperative bleeding volume of patients in NEHE group were significantly less than those in CHE group (p <"0.05). There was no significant difference in the volume of residual hematoma and the incidence of rebleeding between the two groups (p >"0.05). The length of stay in ICU in NEHE group was significantly shorter than that in CHE group (p <"0.05). Conclusion: Neuroendoscopy can safely and effectively remove the intracranial hematoma in patients with hypertensive intracerebral hemorrhage and cerebral hernia, significantly shorten the operation time, reduce the amount of intraoperative hemorrhage, shorten the ICU stay. [ABSTRACT FROM AUTHOR]

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]

Intracranial hematoma (ICH) volume is considered a predictor of clinical outcome and mortality rate in ICH patients with traumatic brain injury (TBI). The ABC/2 method for ICH volume is the standard method used to date, however, its level of accuracy has been questioned in some studies. This study compared the performance of the ABC/2 method with planimetry and truncated pyramidal methods to highlight the potential of the planimetry method applied with automatic segmentation for evaluation of epidural hematoma (EDH) and intraparenchymal hematoma (IPH) volume. Six different phantoms were designed to evaluate the accuracy of volume estimation methods. 221 hematoma regions extracted from CT scans of 125 patients with head injury were also used to analyze the efficiency. The roundness index was utilized for the quantification of the ellipsoid-like shape. Regions of EDH and IPH on the CT scans were annotated by radiologists. The estimation errors for each method were statistically analyzed and compared. In addition, the relationship between the errors and roundness index was examined. The planimetry method showed the lowest relative error on phantom data. In the case of the CT scan data, the truncated pyramidal method resulted in the underestimation of the volumes of EDH and IPH. Meanwhile, the ABC/2, through principal component analysis (PCA) in the two-dimensional and PCA in the three-dimensional methods, resulted in a significant overestimation. In addition, both these approaches produced relative errors that showed a correlation with the roundness indexes for IPH. In comparison to other methods, the planimetry method had the lowest level of error with regards to calculation of the volume and it was also independent of the hematoma shape. The planimetry method, therefore, has the potential to serve as a useful tool for the assessment of ICH volume in TBI patients by using a deep learning system. [ABSTRACT FROM AUTHOR]

Objectives: Ultrasound Needle, which is an improved ultrasonic horn device, has shown great potential for promoting the diffusion of thrombolytic drugs within clots and enhancing clot lysis efficiency. However, the clot lysis efficiency of different thrombolytic drugs with the synergy of Ultrasound Needle remains unknown. In this study, we aimed to compare the lysis efficiency of the non-fibrin-specific drug urokinase and fibrin-specific drug reteplase with the synergy of Ultrasound Needle. Materials and methods: Twenty-five milliliters of human blood was incubated for 1.5 h to form in vitro clots and then received the corresponding treatment protocols: control group (normal saline), US group (10 min of Ultrasound Needle treatment), UK group (30000IU of urokinase), r-PA group (2 mg of reteplase), US + UK group, and US + r-PA group. After treatment, the morphological changes of the clots were analyzed by B-mode ultrasound imaging and hematoxylin and eosin (H&E) staining. Lysis efficiency was evaluated based on the relative end weight (final weight/initial weight). The fibrin density of the different groups after treatment was assessed by immunofluorescence staining. Results: Morphological examination and relative end weight analysis showed that combination therapies induced a more thorough dissolution of clots compared with single therapies, and the US + r-PA group exhibited higher lysis efficiency than the US + UK group. In addition, immunofluorescence staining showed that the US + r-PA group had fewer remaining thrombus fibrins than the US + UK group after treatment. Conclusions: The Ultrasound Needle can significantly improve the clot lysis efficiency of both fibrinolytic drugs, and fibrin-specific reteplase exhibited superior lysis efficiency over non-fibrin-specific urokinase with the synergy of the Ultrasound Needle.

Jiawei Cai,1– 3,&ast; Chao He,4,&ast; Jiaheng Xu,1– 3,&ast; Qiu He,1– 3 Jinye Su,1– 3 Zanyi Wu,1– 3 Yawen Xu1– 3 1Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China; 2Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China; 3Fujian Provincial Institutes of Brain Disorders and Brain Sciences, First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China; 4Department of Neurosurgery, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yawen Xu; Zanyi Wu, Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, Fujian, 350005, People’s Republic of China, Email xuyawen121314@163.com; kirby98@126.comObjective: To identify whether intracranial hematoma (ICH) evacuation improves the prognosis of patients with ruptured anterior communicating artery (AcomA) aneurysms concomitant with small ICHs (≥ 10 mL and < 25 mL).Methods: Data on patients diagnosed with small ICHs secondary to ruptured AcomA aneurysms who underwent surgery in our department between January 2010 and February 2018 was retrospectively analyzed. The patients were divided into two groups based on whether the hematoma was evacuated. The modified Rankin Scale (mRS) was used to assess prognosis six months after onset.Results: The study recruited 58 patients, 19 of whom underwent aneurysm clipping and ICH evacuation. While 33 patients underwent aneurysm clipping, 6 patients underwent coiling embolism without ICH evacuation. The average ICH volume was 15.27± 4.07 mL. In the hematoma-evacuated group, 13 (68.4%) patients had unfavorable outcomes (mRS scores of 4 to 6). In the non-evacuated hematoma group, 13 (33.3%) patients had unfavorable outcomes (P = 0.001), postoperative infarction occurred in 11 (57.9%) patients in the hematoma evacuation group and 9 (23.1%) patients in the other group (P = 0.009).Conclusion: ICH evacuation was associated with unfavorable outcomes and postoperative infarction in ruptured AcomA aneurysms with concomitant small hematomas (< 25 mL). Aneurysm clipping or coiling without ICH evacuation may be a safe and effective choice; however, further investigation is needed.Keywords: AcomA aneurysms, intracranial hematoma, infarction, prognosis, ICH evacuation

In this paper, we reported the first case of mirrored spontaneous intracranial hemorrhage with almost identical hematoma morphological characteristics. This patient's first symptom was loss of consciousness, without any local neurological symptoms. This clinical presentation fits well with the atypical computed tomography (CT) image showing bilateral hematomas, and indicates that the distribution of hypertensive vascular damage may be symmetric and that the degree of the bilateral lesions may be similar. [ABSTRACT FROM AUTHOR]

Dural metastases of prostate adenocarcinoma are an extremely rare complication and may mimic intracranial hematoma. Preoperatively diagnosis may be difficult due to similarities in symptoms and radiological appearance. We present a 65-year-old man admitted to the ED with a history of headache, nausea, vomiting, vertigo, diplopia, as well as numbness of his left lower extremity. Past medical history confirmed metastatic prostate cancer disease. After computed tomography and contrast computed tomography, the consulting radiologist diagnosed a chronic subdural hematoma. After burr hole trephination and dural opening, tumorous mass was detected. Histopathologic samples were taken. Histopathological examination was consistent with metastatic adenocarcinoma of the prostate. Although rare, dural metastases need to be included in oncological patients presenting in the ED with symptoms and radiological imaging suggesting hematoma. Both neurooncological and neurosurgical consultations are essential in order to apply the best treatment strategy. [ABSTRACT FROM AUTHOR]

Intracranial bleed in the form of subdural hematoma (SDH) with intracranial hypotension after spinal anesthesia for cesarean section is a rare condition with an incidence of around 1 in 5,00,000 obstetric populations. As its presentation is similar to post-dural puncture headache (PDPH), it can be misdiagnosed sometimes. Persistent headache for more than 5 days, vomiting, blurring of vision, and convulsion can guide the diagnosis of intracranial bleed. Magnetic resonance imaging (MRI) helps to diagnose the location, size, and other abnormalities of bleed in such patients. The management ranges from conservative to surgical management in the form of craniotomy. Here, we present a case of a 19-year-old woman, who operated on for cesarean section under spinal anesthesia presented with SDH and intracranial hypotension on postoperative day (POD) 6. She was managed conservatively with plenty of intravenous (IV) fluids, bed rest, low head position, analgesics, and antiepileptics. A repeat computed tomography (CT) scan was performed after 14 days, which showed resolved SDH, and the patient was discharged. [ABSTRACT FROM AUTHOR]

Vertex epidural hematoma (vEDH) is a rare type of intracranial hematoma, which accounts for 0.024% of all head injuries and 0.47 to 8.2% of intracranial hematoma, with high mortality rate of approximately 50% if not detected early. We report a case of 30-year-old male with fall from height presenting with headache and bradycardia. Craniotomy with complete evacuation of vEDH was done. vEDH is a relatively rare entity and in suspected case of vEDH one should always get thin cuts of computed tomography along with sagittal and coronal cuts. [ABSTRACT FROM AUTHOR]

对脑血管病患者的脑组织氧合情况实施床旁监测，对脑血管病的诊治及预后改善有重要价值。近红外光谱成像（near infrared spectroscopy，NIRS）作为一项新兴的脑成像技术，具有价格低廉、操作便捷、非侵入性等优点，逐渐成为脑血管病研究的焦点。本文介绍了NIRS的基本原理，探讨了NIRS在急性脑梗死早期识别、梗死后再灌注疗效评估、大面积脑梗死继发恶性脑水肿预测等方面的应用价值，预测了NIRS在大脑近皮层出血病情监测中的应用前景。此外，在蛛网膜下腔出血诊疗领域，NIRS通过动态监测脑氧饱和度，在迟发性脑缺血监测及术后功能结局预测等方面也有着较大的应用潜力。最后，本文基于NIRS的优势和不足，展望了未来适合NIRS应用的临床场景。加强NIRS在脑血管病领域的研究，将使实时评估脑血管病院前、院内的精准动态成为可能。 Bedside monitoring of cerebral oxygenation in patients with cerebrovascular diseases is of great value for the diagnosis, treatment and prognosis of cerebrovascular diseases. As a novel brain imaging technology, near infrared spectroscopy (NIRS) has the advantages of low price, good convenience and non-invasiveness. It has gradually become the focus of cerebrovascular disease research. This article introduced the basic principle of NIRS, the application of NIRS in early recognition of acute cerebral infarction, efficacy evaluation of reperfusion after infarction, and prediction of malignant cerebral edema secondary to large cerebral infarction, and also the application prospect of NIRS in monitoring the hemorrhage near cerebral cortex. For patients with subarachnoid hemorrhage, NIRS may play a great potential role in monitoring delayed cerebral ischemia and predicting postoperative functional outcome by dynamical monitoring cerebral oxygen saturation. Finally, based on the advantages and disadvantages of NIRS, we looked forward to the clinical scenarios suitable for NIRS application in the future. Further NIRS research in cerebrovascular disease will make accurate pre-hospital and in-hospital real-time dynamic assessment of cerebrovascular disease possible.

Chronic subdural hematoma (CSH) in the posterior fossa is extremely rare in the adult population. CT scanning is generally accurate and sufficiently sensitive in the diagnosis of supratentorial subdural hematomas, while MRI has clearly shown its superiority in the detection of subdural collections at unusual locations and particularly in the detailed analysis of the posterior cranial fossa. The surgical strategy is still controversial. We report a case of CSH in the posterior fossa successfully treated with a suboccipital craniectomy. A 70-year-old man; has developed headaches, nausea, cerebellar syndrome and ataxia of walking. Radiological examinations revealed the appearance of a right CSH in the posterior fossa associated with hydrocephalus. Upon rapid deterioration of the patient’s consciousness, urgent treatment was required. A small right suboccipital craniectomy was to access the hematoma. Postoperative computed tomography showed that the CSH and hydrocephalus had been successfully treated.

Background: Ectopic meningiomas are rare neoplasms that occur entirely outside the intracranial and intraspinal cavities and account for only 1–2% of all meningiomas. These tumors have been reported at various sites, however they are predominantly observed in the head and neck region. Here, we detail a case of an adult diagnosed with ectopic meningioma of the neck. Case presentation: A 26-year-old woman underwent evaluation for a neck swelling associated with difficult in swallowing. Clinical examination revealed a firm, non-tender and non-pulsatile swelling in the right side of neck. On imaging, a soft tissue mass lesion was seen involving the right supra-hyoid neck, centered at the right carotid space/retro-styloid parapharyngeal space. She underwent maximal safe resection of the tumor and a consensus was reached regarding the diagnosis of ectopic meningioma based on the histopathological, clinical and radiological findings. Relevant literature is reviewed. Conclusions: The diagnosis of ectopic meningioma may pose difficulties due to their occurrence in uncommon sites. The primary approach to treatment entails the surgical removal of the neoplasm, and a multidisciplinary strategy is pivotal for achieving the best possible clinical outcomes for patients with this rare entity. [ABSTRACT FROM AUTHOR]

There is a lack of evidence on spinal subarachnoid hematomas because of the rarity of their spontaneous development and difficulty in diagnosis. The aim of this study was to identify the characteristics and outcomes of surgically confirmed acute non-traumatic spinal subarachnoid hematomas from a multicenter surgical database and conduct a systematic review of existing literature. Five surgically confirmed cases of acute non-traumatic spinal subarachnoid hematomas were identified from our multicenter database with 22 cases from a systematic review of existing literature. The mean age of the 27 patients was 59 years. The length of the hematoma was longer than five vertebrae in 70% of the patients, most commonly distributed in the thoracic spine; 63% of all cases were idiopathic, 30% were under anticoagulant therapy, and the remaining 7% presented with coagulation abnormalities. As many as 70% of the patients showed some improvement in neurological symptoms after surgery during a mean follow-up period of 14 months. This study elucidated the characteristics of acute non-traumatic spinal subarachnoid hematomas in patients who were surgically confirmed. Most patients were middle-aged, complained of back pain, and had the hematoma located in the thoracic spine. Seventy percent of the patients in this study had some improvement in their neurological status, most likely due to surgical decompression and hematoma evacuation. [ABSTRACT FROM AUTHOR]

Copyright of Lijecnicki Vjesnik is the property of Croatian Medical Association 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.)