Cases Of Intracranial Hematoma Research Articles

A Case of Spontaneous Intracranial Hematoma with Critically Low Platelet Count: A Neurointensivist's Nightmare

AbstractComplications of immune thrombocytopenia (ITP) are more frequent at a platelet count lower than 10,000/μL of blood. Intracranial hematoma (ICH) is one of the most severe complications of ITP. Subdural hematoma (SDH) and subarachnoid hemorrhage (SAH) usually occur as extensions of ICH and is generally spontaneous in nature. We report a case of ICH along with SDH and SAH who presented with critically low platelet count managed using apheresis platelet transfusion, desmopressin, intravenous immunoglobulin, and methylprednisolone. The patient was discharged successfully from hospital without any neurological deficit. The importance of early referral and immediate aggressive management and monitoring at an advanced center is suggested.

Pretemporal Transcavernous Approach for Resection of Non-meningeal Tumors of the Cavernous Sinus: Single Center Experience.

ObjectivesTo study the outcomes of the pretemporal transcavernous approach in the treatment of non-meningeal tumors involving cavernous sinus and to investigate the surgical strategy for these lesions.MethodsWe conducted a retrospective study of 45 patients with non-meningeal tumors involving cavernous sinus. All 45 patients received microsurgical resection via the pretemporal transcavernous approach from April 2012 to January 2019 by the same neurosurgeon. We analyzed clinical manifestations, image data, perioperative complications, surgical outcomes, functional outcomes, and follow-up data of these patients.ResultsGross total resection was achieved in 38 cases (84.4%) of the 45 patients. Preoperatively, a total of 64 individual cranial nerves were affected. Postoperatively, 92.2% of 64 impaired cranial nerves completely or partially restored function, 7.8% had worsened function compared with their preoperative statuses, and 5 new cranial nerve deficits (CNV) were observed in five patients during the last follow-up. Seven patients presented transient new cranial nerve deficits (5 CNIII and 2 CNVI), three cases suffered transient worsen cranial nerve deficits (3 CNIII and 1 CNVII). There were no cases of intracranial hematoma, intracranial infection, cerebrospinal fluid leaks, and death. The progression of residual tumor was observed in two patients (1 chordoma and 1 pituitary adenoma).ConclusionsNon-meningeal tumors involving cavernous sinus can be safely and radically removed with less morbidity and mortality. Pretemporal transcavernous approach is an ideal approach to the cavernous sinus and can be tailored individually.

Pseudocapsule-Based Resection for Pituitary Adenomas via the Endoscopic Endonasal Approach.

IntroductionThe endoscopic endonasal approach (EEA) is a safe and effective treatment for pituitary adenomas (PAs). Since extracapsular resection (ER) of PAs improves tumor resection and endocrine remission rates, the interface between the pseudocapsule and gland draws increasing attention. However, it is difficult to precisely dissect the tumor along the exact boundary, and complete removal of the tumor increases the risks of normal tissue damage and cerebrospinal fluid (CSF) leakage. In this study, we investigated the extracapsular resection as well as the pseudocapsule histology to evaluate the effectiveness and safety of pseudocapsule-related surgical interventions.MethodsFrom December 2017 to December 2019, 189 patients of PAs via EEA in our single center were analyzed retrospectively. The images, operative details, and clinical follow-up of patients were collected. Sixty-four patients underwent pseudocapsule-based ER, and 125 patients also underwent traditional intracapsular resection (IR) with or without intensive excision for FPAs. The clinical characteristics, tumor resection, endocrinological outcomes, and postoperative morbidities of the two groups were compared. Informed consent for publication of our article was obtained from each patient. Histological examination of pseudocapsule was performed using hematoxylin and eosin and reticulin staining.ResultsThe gross total recession was 62 (96.9%) in the ER group and 107 (85.6%) cases in the IR group, whereas the endocrine remission rate was 29/31 (93.5%) and 40/53 (75.5%) cases, respectively. Anterior pituitary functions were not aggravated postoperatively in any patient, but transient diabetes insipidus (DI) occurred more in the IR group (64.0%) than in ER (48.4%). Pseudocapsule specimens were obtained in 93 patients, and clusters of small cell aggregation were detected in 11 pseudocapsule specimens (11.8%) whereas other patients showed no remarkable developed pseudocapsule. Intraoperative CSF leak occurred more in the ER group (28.1%) than in the IR group (13.6%), but no difference was seen between two groups postoperatively. No case of intracranial hematoma or pituitary crisis occurred in both groups. After a mean follow-up of 22.8 months, tumor recurrence was observed in 4 (2.1%) cases.ConclusionPseudocapsule-based extracapsular resection of PAs via EEA is an effective and safe procedure to achieve complete resection with high and sustained endocrine remission and without deteriorating pituitary function.

Efficacy of the Suboccipital Paracondylar-Lateral Cervical Approach: The Series of 64 Jugular Foramen Tumors Along With Follow-Up Data.

ObjectiveComplete resection of jugular foramen tumors with minimal cranial nerve complications remains challenging even for skilled neurosurgeons. Here, we introduce a modified paracondylar approach, named the suboccipital paracondylar-lateral cervical (SPCLC) approach for this purpose. We also share the follow-up data of our series and discuss the advantages and limitations of this modified paracondylar approach.MethodsWe included 64 patients with jugular foramen tumors who underwent surgery by the same senior neurosurgeon between November 2011 and August 2020. All patients were treated with the SPCLC approach, which aimed for gross total tumor removal in a single-stage operation. The clinical characteristics, including preoperative and postoperative neurological status, the extent of surgical resection, and follow-up data were retrospectively acquired and evaluated.ResultsThere were 48 schwannomas, nine meningiomas, three paragangliomas, one hemangiopericytoma, one chordoma, one endolymphatic sac tumor, and one Langerhans’ cell histiocytosis. The median age of our patients was 43 years (range: 21–77 years). Dysphagia, hoarseness, and tongue deviation were observed in 36, 26, and 28 patients, respectively. Thirty-two patients had hearing function impairments, including hearing loss or tinnitus. Gross total resection was achieved in 59 patients (59/64, 92.2%). Gamma Knife treatment was used to manage residual tumors in five patients. Postoperatively, new-onset or aggravative dysphagia and hoarseness occurred in 26 and 18 cases, respectively. Nine patients developed new-onset facial palsy, and one patient developed new-onset hearing loss. There were no cases of intracranial hematoma, re-operation, tracheostomy, or death. At the latest follow-up, hearing loss and tinnitus had improved in 20 cases (20/32, 62.5%), dysphagia alleviated in 20 cases (20/36, 55.6%), and hoarseness improved in 14 cases (14/26, 53.8%). Over a mean follow-up period of 27.8 ± 19.5 months (range: 3–68 months), tumor recurrence was observed in one patient.ConclusionThe SPCLC approach, modified from the paracondylar approach, and was less invasive, safe, and efficient for certain jugular foramen tumors. Taking advantage of the anatomic understanding, clear operational vision, and appropriate surgical skills, it is possible to achieve gross total tumor removal and the preservation of neurological function.

INTRA-CRANIAL HEMATOMAS SECONDARY OF HEAD INJURIES SEEN AT CHU PZAGA OF MAHAJANGA

Head trauma regroups every post-traumatic lesions surgical or not concerning the skul l, its envelopes and its contents especially. The aim of the study was to determine the epidemi ological, clinical and treatment profile of intra-cranial post traumatic hematoma at neurosurgi cal unit of PZaGa University Teaching Hospital. It is a retrospective, descriptive study about head injury with intra-cranial hematoma a dmitted and managed at the neurosurgical unit from December 2017 to July 2018. We had 244 cases of head trauma among 325 hospitalized patients with 34 cases of int ra-cranial hematoma (13, 93%). Patients with head trauma were young adults, with male pred ominance, living in Mahajanga town. The main risk factor found was alcoholic intoxication (52,94%). It was about benign head trauma (79, 41%), among main signs found was agitation.Brain CT Scan was used in 82,35% of cases. Surgical indication was almost confirmed by C T Scan but for the 17, 65% of cases, diagnosis was confirmed per-operatively. Main lesions o bserved were EDH (42, 86%) and chronic SDH (21,43%). Their management was early. Med ical treatment was sufficient in 20,59% of patients and 79,41% had surgical intervention. Evo lution was favorable but we had 2,94% deaths.Information, communication and education of a very socio professional stratus should be done.

Optimal surgical approaches and treatment outcomes in patients with jugular foramen schwannomas: a single institution series of 31 cases and a literature review.

Complete resection of jugular foramen schwannomas (JFSs) with minimal cranial nerve complications remains difficult even for skilled neurosurgeons. Between November 2011 and November 2017, 31 consecutive patients diagnosed with JFSs underwent a single-stage operation performed by the same neurosurgeon. We retrospectively analyzed clinical characteristics, surgical approaches, treatment outcomes, and follow-up data for these patients. JFSs were classified according to the Samii classification system. A retrosigmoid approach was used to resect type A tumors, while a suboccipital transjugular process (STJP) approach was used to resect type B tumors. Notably, the present study is the first to report the use of a paracondylar-lateral cervical (PCLC) approach for the treatment of type C and D tumors. Type A-D tumors were observed in seven, four, four, and 16 patients, respectively. Gross-total resection was achieved in 29 patients (93.5%). There were no cases of intracranial hematoma, re-operation, tracheotomy, or death. Adjunctive gamma knife treatment was used to manage residual tumors in two patients. Neurological deficits relieved in half of patients at the last follow-up. By reviewing the studies published on PubMed, the approaches gradually be more conservative, rather than widely expose the skull base. Nonetheless, endoscope and stereotactic radiosurgery plays an important role in the management of JFSs. Both tumor removal and neurological function retention can be obtained by choosing individual treatment.

Analysis of risk factors for postoperative recurrence of chronic subdural hemotoma

Objective To explore the risk factors of recurrence of chronic subdural hematoma after drilling and drainage. Methods Clinical data of 142 patients with chronic subdural hematoma admitted to Department of Neurosurgery, Zhongshan Hospital, Xiamen University from January 2013 to December 2016 were collected and retrospectively analyzed. Univariate (chi-square test) and multivariate (logistic regression test) were used to analyze the risk factors for postoperative recurrence of chronic subdural hematoma. Results The postoperative follow-up period of 142 patients was 3 to 24 months. Among them, 21 patients had hematoma after operation and the recurrence rate was 14.8%. Postoperative complications included 4 cases of epilepsy, 2 cases of intracranial infection, 10 cases of subdural effusion, 1 case of intracranial hematoma, and 23 cases of atonic pneumocephalus. Univariate analysis demonstrated that age of onset, anticoagulation, preoperative width of hematoma, preoperative midline shift and postoperative width of subdural space were associated with postoperative recurrence of chronic subdural hematoma (all P<0.05). Multivariate analysis showed that age (OR=20.914, 95%CI: 3.451-126.741), preoperative anticoagulant medication (OR=10.679, 95%CI: 1.873-60.880), preoperative width of hematoma (OR=3.602, 95%CI: 1.029-12.611) and preoperative midline shift (OR=4.613, 95%CI: 1.222-17.418)were significantly associated with postoperative recurrence. Conclusions The postoperative recurrence in patients with chronic subdural hematoma is related to multiple factors. Age ≥70 years, preoperative anticoagulation, preoperative width of hematoma ≥20 mm and preoperative midline shift ≥10 mm were independent risk factors for postoperative recurrence of chronic subdural hemotoma. Key words: Hematoma, subdural, chronic; Recurrence; Risk factor analysis

Analysis of Etiology, Diagnosis and Treatment of Neonatal Pathological Jaundice

&lt;strong&gt;Objectives: &lt;/strong&gt;To investigate the causes of neonatal pathological jaundice and provide the basis for clinical diagnosis and treatment. &lt;strong&gt;Method: &lt;/strong&gt;The clinical data of 120 cases of neonatal jaundice were analyzed retrospectively. &lt;strong&gt;Results: &lt;/strong&gt;In the cause of the disease, 22 cases of neonatal asphyxia, accounting for 21, 17.50% cases of breast feeding, accounting for 13, 10.83% cases of ABO hemolytic disease, accounting for 24.17%, 8 cases of cesarean section, accounting for 6.67%, 5 cases of premature delivery, accounting for 4.17%, 6 cases of intracranial hematoma, accounting for 5%. Infection, breast feeding, neonatal asphyxia, ABO blood group incompatibility is an independent factor. 120 cases were cured and discharged. No serious sequelae and dysfunction occurred. &lt;strong&gt;Conclusion: &lt;/strong&gt;To strengthen the perinatal health care, and pay attention to the prevention and treatment of risk factors, such as infection, neonatal asphyxia, and the use of appropriate breast feeding, can effectively reduce the incidence of neonatal pathological jaundice.