Craniotomy Hematoma Removal Research Articles

Middle Meningeal Arterial Embolization Combined With Drilling in the Treatment of Acute Epidural Hematoma.

The purpose of this study was to determine the technical feasibility and safety of middle meningeal arterial (MMA) embolization combined with drilling drainage in the treatment of acute epidural hematoma (AEDH) by comparing it with traditional craniotomy in the treatment. One hundred seventeen patients with AEDH treated for MMA embolization combined with drilling and drainage or craniotomy hematoma removal from January 2017 to September 2020 were retrospectively analyzed and divided into a craniotomy group (n=85) and a minimally invasive group (n=32). Hematoma removal was performed in the craniotomy group, and MMA embolization combined with drilling and drainage was performed in the minimally invasive group. The general clinical data, imaging data, surgery, and follow-up of the 2 groups were compared and analyzed. Compared with the craniotomy group, the residual hematoma volume in the minimally invasive group was higher than in the craniotomy group. The average postoperative drainage duration in the minimally invasive group was longer than in the craniotomy group. Compared with the craniotomy group, the minimally invasive group was associated with shorter operative time, less intraoperative bleeding, and lower rates of postoperative rebleeding. In addition, the incidence of postoperative complications and length of hospitalization in the minimally invasive group were significantly shortened. Middle meningeal arterial embolization combined with drilling and drainage in the treatment of AEDH caused by MMA active bleeding is safe, effective, and more minimally invasive, and can be promoted and applied.

Meta-analysis of stereotactic hematoma removal and craniotomy hematoma removal in the treatment of hypertensive intracerebral hemorrhage in the elderly.

A large number of clinical studies suggested that surgery might be a better choice than conservative treatment for treating hypertensive intracerebral hemorrhage in the middle-aged and elderly. Stereotactic puncture can reduce the mass effect caused by hematoma, reduce the intervention of body homeostasis, reduce brain tissue damage, and improve the prognosis of patients with cerebral hemorrhage. This meta-analysis aims to evaluate the efficacy of stereotactic puncture and craniotomy in elderly patients with hypertensive intracerebral hemorrhage. A search strategy was designed to search in databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, CNKI, Wanfang database and relevant references. Literature on the efficacy and safety of different surgical methods for hypertensive cerebral hemorrhage in the middle-aged and elderly were retrieved. The search time was until August 17, 2022. Keywords included "hypertensive intracerebral hemorrhage," "stereotactic hematoma removal," "craniotomy." After the literature search, 2 researchers independently conducted literature screening, quality evaluation of included trials and data extraction. RevMan5.4 software was used to perform a Meta-analysis on the operation time, hospital stay, postoperative Glasgow Coma Scale (GCS) score, postoperative daily activity ability, postoperative complications and neurological prognosis scores included in the included studies. A total of 1988 samples were included in 9 studies. 1022 patients underwent stereotactic hematoma removal, and 968 patients underwent craniotomy hematoma removal. The orientation group had more advantages in the length of hospital stay, postoperative disability, pulmonary infection, intracranial infection and digestive tract ulcer, and the difference was statistically significant (P < .05). In addition, the length of stay (I²= 83%) of the included articles had good homogeneity (I²< 50%), and there was no significant difference between the 2 groups in operation time, postoperative GCS score, postoperative daily activity ability, and neurological prognosis score (P > .05). The meta-analysis indicate that compared to craniotomy for hematoma removal, stereotactic hematoma removal can reduce the postoperative disability rate, intracranial infection rate, lung infection rate, and digestive tract ulcer rate in middle-aged and elderly patients with hypertensive intracerebral hemorrhage.

Subacute stent thrombosis with spontaneously resolved secondary thrombi in paroxysmal nocturnal hemoglobinuria: a case report

BackgroundStent thrombosis (ST) is a serious complication; however, a method to prevent ST in patients with thrombophilic diseases has not been established.Case presentationWe report a case of subacute ST in a patient with paroxysmal nocturnal hemoglobinuria (PNH) who was receiving continuous heparin treatment in addition to the usual dual antiplatelet therapy for contrast defects at the proximal site of the occluded right coronary artery and the proximal site of the left circumflex artery. Despite the resolution of thrombi in secondary lesions, subacute ST occurred. After percutaneous coronary intervention for ST, triple therapy, including oral anticoagulation for PNH-related thrombosis, was initiated. The patient subsequently underwent craniotomy hematoma removal for hemorrhagic cerebral infarction.ConclusionsReported cases of ST in patients with PNH are very few, and this case adds evidence with respect to antithrombotic therapy in patients with thrombotic tendencies. Both thrombosis and bleeding should be considered when administering antithrombotic therapy to patients with thrombotic diseases. If there are specific treatments for thrombophilic diseases, they should be initiated early.

Effect Evaluation of Dexmedetomidine Intravenous Anesthesia on Postoperative Agitation in Patients with Craniocerebral Injury by Magnetic Resonance Imaging Based on Sparse Reconstruction Algorithm.

The effect of dexmedetomidine on postoperative agitation of patients with craniocerebral injury was investigated based on magnetic resonance imaging (MRI) with the sparse reconstruction algorithm. Sixty patients with craniocerebral injury who underwent tracheal intubation and craniotomy hematoma removal under general anesthesia in hospital were selected as the research objects. Patients were randomly and averagely divided into the normal saline group (group A) and the dexmedetomidine (DEX) group (group B). DEX was added to patients in group A during anesthesia. Other operations in group B were the same as those in group A, where DEX needed to be used was replaced by an equal amount of the normal saline. All patients received the MRI examination, and the images were processed by using the sparse reconstruction algorithm. After the surgery, some indexes, such as hemodynamics (mean arterial pressure (MAP) and hear rate (HR)), the Riker sedation agitation score, the Ramsay sedation score, and the visual analogue scale (VAS) score were recorded and compared. The results showed that the MRI image quality processed by sparse reconstruction algorithm was observably improved. After reconstruction, the sharpness of the image was significantly improved, and the distinction between lesions and tissues was also increased. The Riker sedation agitation score and the incidence of agitation in group A were greatly lower than those in group B (16% VS 76%, P < 0.05). The Ramsay sedation score of group A was manifestly higher than that of group B. The cases of postoperative nausea, vomiting, chills, delirium, and bradycardia in group A were 2, 1, 1, 0, and 1, respectively. The cases of postoperative nausea, vomiting, chills, delirium, and bradycardia in group B were 3, 9, 6, 5, and 0, respectively. The cases of chills and delirium in group A were observably less than those in group B (P < 0.05). In conclusion, based on the sparse reconstruction algorithm, the MRI technology and DEX had high adoption value in preventing postoperative agitation of patients with craniocerebral injury. Compared with group B, the hemodynamics of patients in group A was more stable.

Effects of different sedatives/analgesics on stress responses in patients undergoing craniotomy and bone flap decompression.

ObjectiveTo explore the effects of sedation and analgesia with dexmedetomidine and other drugs on the stress response in patients with cerebral hemorrhage after craniotomy hematoma removal and bone flap decompression and insertion of an indwelling endotracheal catheter.MethodsA total of 180 patients with cerebral hemorrhage with consciousness disturbance who underwent emergency surgery were included in this study. They were divided into six groups treated with propofol, dexmedetomidine, lidocaine, sufentanil, dezocine, and remifentanil, respectively. Intravenous medication was given after recovery of spontaneous respiration, and stress responses were compared among the group.ResultsSerum concentrations of norepinephrine, epinephrine, and cortisol and systolic blood pressure were significantly correlated with drug treatment. Serum norepinephrine concentrations differed significantly among the groups, except between the sufentanil and propofol groups. There were significant differences in serum epinephrine concentrations among all groups, and significant differences in serum cortisol concentrations among all groups, except the propofol, dexmedetomidine, and lidocaine groups.ConclusionDexmedetomidine can reduce the stress response in patients with intracerebral hemorrhage undergoing emergency craniotomy and bone flap decompression, and can reduce adverse events from an indwelling endotracheal catheter 3 hours post-operation.

Comparison of Clinical Efficacy between Minimally Invasive Intracranial Hematoma Puncture and Drainage and Traditional Craniotomy Hematoma Removal in Patients with Hypertensive Intracerebral Hemorrhage

Comparison of Clinical Efficacy between Minimally Invasive Intracranial Hematoma Puncture and Drainage and Traditional Craniotomy Hematoma Removal in Patients with Hypertensive Intracerebral Hemorrhage

Imaging Features of Artificial Intelligence Algorithm in the Analysis of Cerebral Protective Effect of Craniotomy Hematoma Removal under Propofol Anesthesia in Patients with Chronic Subdural Hematoma

Objective. The aim of this work was to study the cerebral protective effect of craniotomy hematoma removal under propofol anesthesia based on the artificial intelligence algorithm analysis of the changes in imaging characteristics of chronic subdural hematoma (CSDH) patients. Methods. A total of 60 CSDH patients who were treated in hospital were recruited and were randomly rolled into an experimental group and a control group, with 30 people in each group. Patients in the experimental group were treated with propofol anesthesia + craniotomy hematoma removal, while those in the control group were treated with conventional anesthesia + craniotomy hematoma removal. Head CT examinations were performed on the next day, one week, one month, three months, and six months after the operation. A two-dimensional empirical mode decomposition (BEMD) algorithm was used for edge detection and denoising of brain CT images of CSDH patients. Then, the amount of hematoma was calculated, and the Markwalder grading was performed to evaluate the neurological function. The number of recurrence and reoperation cases within six months of follow-up was collected. Results. 1. The quality of CT images was remarkably improved after processing with artificial intelligence algorithms. 2. The amount of hematoma in the experimental group was remarkably lower than that in the control group at January, March, and June after surgery (12.89 ± 2.12 VS 20.32 ± 16.41; 7.55 ± 4.13 VS 15.88 ± 14.22; 3.39 ± 3.79 VS 6.55 ± 3.69, P &lt; 0.05 ). 3. The experimental group was remarkably better than the control group in Markwalder grading three months and six months after the operation ( P &lt; 0.05 ). Conclusion. Artificial intelligence algorithm had good effect on the brain CT image processing of CSDH patients, and craniotomy hematoma removal under propofol anesthesia had an ideal brain protection effect.

Management of Spontaneous Superficial Intracerebral Hematomas

Background: Treatment of primary spontaneous superficial intracerebral hemorrhage (SSICH) is still controversial. The aim of this study is to investigate the effectiveness of craniotomy and early hematoma evacuation vs conservative (non operative) management in patients with SSICH. Methods: A prospective study of craniotomy and early hematoma removal vs. medical management was performed in 20 patients with cortical and subcortical (superficial) primary SSICH admitted to Assiut university hospital in one year period (March 2016-March 2017). Surgical or medical treatment was initiated immediately when patients admitted to hospital. We divided the patients into two groups according to type of treatment. Results: Age of the patients ranged from 2 months to 73 years (mean: 45.84 ± 23.28 years) among the 20 patients studied; 13 (65%) were males and 7 (35%) were females. Glasgow coma scale (GCS) at admission was less than 8 in 25%, between 8 - 12 in 45% and 15 in 30% of the patients. Arterial hypertension was the most common associated medical disease (65%). Eleven of patients (55%) had ventricular extension. GCS at admission was the strongest factor affecting outcomes and determined the type of treatment. All patients with a GCS ≤ 8 (5 cases (25%) were died regardless the type of treatment and there was no significant statistical difference in this group in relation to type of treatment p-value (0.606). We had 6 cases (30%) with a GCS 15; all of them were treated conservatively and all of them survived with significant p-value (0.003). Nine patients (45%) had GCS 8 - 12; two of them were treated conservatively and died while the remaining seven patients were treated surgically; five of them survived with significant p-value (0.025). No significant statistical difference was found in the outcome between the surgical and the conservative group regarding having associated intracranial hemorrhage. Conclusions: After analyzing the results, we found that when the GCS is “8 - 12”, surgical intervention is recommended and carried a better prognosis than waiting for the conservative treatment. When GCS is higher “>12”, conservative treatment can be the favorable option. Otherwise, we found no statistical difference between surgical and conservative treatment in the treatment of ICH.

Influencing factors of cerebral infarction in elderly patients with hypertensive intracerebral hemorrhage after hematoma clearance

Objective To investigate the influencing factors of cerebral infarction in elderly patients with hypertensive intracerebral hemorrhage after hematoma clearance. Methods A total of 197 elderly patients with hypertensive intracerebral hemorrhage were selected and treated with craniotomy hematoma removal and decompression of bone flap. Cerebral infarction was checked by craniocerebral CT after operation.Univariate and multivariate Logistic regression analysis was used to identify the independent risk factors for cerebral infarction. Results The incidence of cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage was 26.90%(53/197). There was no significant difference in the incidence of cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage on gender and age (P>0.05), while the differences were statistically significant in diabetes(χ2=7.986), hypertension history(χ2=10.399), hematoma volume(χ2=10.396), edema(χ2=12.436), systolic blood pressure(χ2=12.128), diastolic blood pressure(χ2=13.040) and GCS score(χ2=3.940) (all P 35 ml(β=2.361, OR=3.890, 95%CI=1.792-5.132), area of brain edema (> 65 cm3) (β=2.471, OR=4.321, 95%CI=1.879-5.487), systolic pressure (> 150 mm Hg, 1 mmHg=0.133 kPa) (β=2.073, OR=3.172, 95%CI=1.428-4.768), diastolic pressure (> 90 mm Hg) (β=1.715, OR=2.498, 95%CI=1.276-3.451)and GCS score < 8(β=2.592, OR=4.871, 95%CI=1.974-5.798)were independent risk factors for cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage. Conclusion Elderly patients with cerebral infarction after hematoma clearance in hypertensive intracerebral hemorrhage is affected by diabetes mellitus, hypertension, hematoma volume, edema, systolic blood pressure, diastolic blood pressure and other factors. Early intervention on these factors may effectively reduce the incidence of cerebral infarction. Key words: Hypertensive cerebral hemorrhage; Hematoma; Cerebral infarction; The elderly; Influencing factors

Effect of bone flap reduction on unilateral acute subdural hematoma under intracranial pressure monitoring

Objective To investigate the effect of bone flap reduction on unilateral acute subdural hematoma (ASDH) under intracranial pressure monitoring. Methods A retrospective case control study was conducted to analyze the clinical data of 139 patients with unilateral ASDH admitted to the First Affiliated Hospital of Xinjiang Medical University from July 2014 to December 2017. There were 84 males and 55 females, aged 19-87 years (mean, 53 years). At the time of admission, the Glasgow Coma Score (GCS) was 3-5 points in 63 patients and 6-8 points in 76. There were 40 patients with unilateral cavity dilation and 16 cases with bilateral pupil dilation. According to the different surgical methods, the patients were divided into study group (n=61) and control group (n=78). The study group removed the cranial hematoma under cranial pressure monitoring and determined whether to perform bone flap reduction according to the actual intracranial pressure. The control group was treated with craniotomy hematoma removal and standard large bone decompressed craniectomy (DC). The success rate of bone flap reduction in the study group was recorded. The complications at postoperative 3 months and the Glasgow Outcome Score (GOS) at postoperative 6 months were compared. Results All patients were followed up for 1-6 months, average 5.5 months. In the study group, 23 patients underwent bone flap reduction, and the bone flap reduction rate was 38%. At postoperative 3 months, the study group showed better efficacy in subdural effusion (9 ∶25), hydrocephalus (7 ∶19), and brain swelling in the skull defect area(5 ∶18) than the control group (P<0.05). Based on the GOS at 6 months after operation, in the study group, 25 patients were with good results, nine with moderate disability, 10 with heavy disability, seven with plant survival, and 10 died; in the control group, six patients were with good results, 21 with moderate disability, 15 with heavy disability, 10 with plant survival, and 26 died. The number of patients with good prognosis (good and moderate disability) and the number of deaths in the study group were statistically different from those in the control group (P<0.05). Conclusion In the treatment of unilateral ASDH, bone flap reduction under intracranial pressure monitoring can reduce the incidence of complications and improve the life quality of patients. Key words: Intracranial pressure; Hematoma, subdural, acute; Reconstructive surgical procedure

Clinical analysis of small skull window craniotomy for hypertensive intracerebral hemorrhage

Objective To investigate the effect of small bone window hematoma ventriculoscope for clinical treatment of hypertensive cerebral hemorrhage. Methods From January 2014 to June 2017, 80 patients with hypertensive cerebral hemorrhage in Zhejiang Rongjun Hospital were selected and randomly divided into two groups according to the digital table, with 40 cases in each group.The control group underwent conventional craniotomy hematoma removal surgery, the observation group received small bone window hematoma ventriculoscope treatment.The operation situation, hospitalization time, clinical efficacy and nerve function defect score, ADL score, the incidence rate of complications were compared between the two groups. Results There was no statisticall significant difference in operation time between the two groups(t=0.284, P>0.05). The amount of intraoperative bleeding of the observation group was (35.47±10.69)mL, which was significantly less than (96.85±27.54)mL of the control group (t=13.141, P<0.05). The hospitalization time of the observation group was significantly shorter than the control group[(8.52±2.31)d vs.(11.79±3.05)d](t=5.405, P<0.05). The total effective rate of observation group was 92.5%(37/40), which was higher than 75.0%(30/40) in the control group(χ2=4.501, P<0.05). After treatment, the neural function defect score and daily life ability score of the observation group were (17.59±2.98) points, (82.45±6.03)points, respectively, which were significantly higher than those of the control group[(22.17±3.06) points, (73.21±5.12) points](t=6.782, 7.388, all P<0.05). The incidence rate of complications of the observation group was 5.0%(2/40), which was significantly lower than 20.0%(8/40) in the control group(χ2=4.114, P<0.05). Conclusion Small bone window craniotomy evacuation of hematoma in the treatment of hypertensive cerebral hemorrhage, not only has significant clinical efficacy, but also has the advantages of less intraoperative blood loss, rapid postoperative recovery, less complications and so on. Key words: Intracranial hemorrhage, hypertensive; Ventricle mirror; Small bone window hematoma clearance

Small craniotomy hematoma removal and middle meningeal artery embolization under local anesthesia to acute epidural hematoma at hybrid operating room : a case report

Small craniotomy hematoma removal and middle meningeal artery embolization under local anesthesia to acute epidural hematoma at hybrid operating room : a case report

Curative effects of minimally invasive evacuation of hematomas and craniotomy hematoma removal

Objective To analyze the efficacy of minimally invasive evacuation of hematomas and craniotomy hematoma removal in the treatment of hypertensive cerebral hemorrhage.Methods 54 patients with hypertensive intracerebral hemorrhage in January 2009 to January 2010,were randomly divided into minimally invasive group and surgical group,27 cases in each group,based on their agreement,we respectively adopted minimally invasive hematoma in patients with comminuted dissection and craniotomy evacuation of hematoma,a comparative analysis of two groups with clinical effect was conducted.Results Compared with the traditional craniotomy group,hypertensive cerebral hemorrhage minimally invasive group was better in the clinical treatment effect(P＜0.05).Conclusion Minimally invasive evacuation of hematomas and craniotomy evacuation of hematoma in treatment of hypertensive cerebral hemorrhage of hypertension have a certain effect,but the clinical effect of minimally invasive hematoma smash removal is better. Key words: Minimally invasive evacuation of hematomas; Craniotomy hematoma removal