Percutaneous Subdural Tapping Research Articles

Comment on "Evaluation of Recurrence Factors and Gorei-san Administration for Chronic Subdural Hematoma after Percutaneous Subdural Tapping"

We previously reported the recurrence factors and the effect of Gorei-san on chronic subdural hematoma (CSDH) using percutaneous subdural tapping. Herein, we comment on less invasive surgical option and postsurgical administration for CSDH. Many factors for CSDH recurrence have been identified and categorized into four groups, namely: patient background, hematoma character, postsurgical administration, and surgical option. Patient background and hematoma character cannot be intervened for patients’ specific problem. Gorei-san has been reported to prevent CSDH recurrence without adverse events even if administered for elder patients. Gorei-san inhibits aquaporin-4, which is expressed on the outer membrane of chronic subdural hematoma. We have good impression of prevention effect of CSDH recurrence especially for those who started Gorei-san before surgery. Several surgical options for CSDH are reported as follows: burr hole surgery, percutaneous subdural tapping, endovascular embolization of middle meningeal artery, and craniotomy. Although burr hole surgery has been performed worldwide as a standard procedure for CSDH, percutaneous subdural tapping has been developed to realize less invasive surgical option, which allows noninvasive measurement of initial hematoma pressure and eases the perioperative management due to rapid discharge.

多房性慢性硬膜下血腫に対する経皮的硬膜下穿刺による血腫と酸素の置換術

多房性慢性硬膜下血腫に対する経皮的硬膜下穿刺による血腫と酸素の置換術

Infantile subdural empyema: The role of brain sonography and percutaneous subdural tapping in a resource-challenged region.

Background:This study explored the outcome of children with patent anterior fontanelles who were treated with trans-fontanelle ultrasound scan (TFUSS), which is more affordable and available than CT scan and MRI in the diagnosis of childhood intracranial pathologies and treatment of subdural empyema, in developing countries.Patients and Methods:Seventeen infants with post-meningitic subdural empyema, diagnosed using trans-fontanelle ultrasound alone and treated with subdural tapping over a 31-months period, were studied.Results:Eleven patients presented with grades II and III Bannister and William grading for level of consciousness in intracranial subdural empyema. Aspirate from 7 (41.2%) patients were sterile. The most common organisms isolated were Streptococcus faecalis 3 (17.6%), Haemophilus Influenza 2 (11.8) and Staphylococcus aureus 2 (11.8), multiple organisms were isolated in three of the patients. Ninety-four percent (94%) of the patients had good outcome. Five subjects developed hydrocephalus, one patient had a recurrence of subdural empyema, four patients had residual hemiparesis, two of the four patients had speech difficulties, while one patient (~6%) died.Conclusion:While CT and MRI remain the gold standard for investigating intracranial lesions, transfontanelle ultrasonography is adequate for diagnosis of infantile subdural empyema in resource-challenged areas. Percutaneous subdural tap is an affordable and effective therapy in such patients with financial challenges.

侵襲の少ない慢性硬膜下血腫の治療

著者らは低侵襲で高齢者に優しい治療として経皮的硬膜下穿刺を開発し報告してきた. その究極的な応用として, 血腫の完全な除去を目的に, 生理食塩水での洗浄によるのではなく, 酸素による置換を考案し, 多数の症例を治療してきた. ここではその具体的な手技について解説するとともに, ポイントとなるコツについても言及した.

Clinical outcomes of temporary shunting for infants with cerebral pseudomeningocele

Although in the case of subdural collections temporary shunting has been suggested as a viable alternative for definitive drainage of the accumulated fluid until restoration of the normal CSF dynamics, there is no agreement on the best management strategy for pseudomeningocele. The authors performed a retrospective chart review in order to evaluate the clinical outcomes of infants temporarily shunted for pseudomeningocele without encephalocele at our institution (The University of Illinois at Peoria/Illinois Neurological Institute) in the period from 2004 to 2012. The epidemiological characteristics, clinical management, and final outcomes of such subpopulation were compared with a control group which received temporary shunting for subdural hematomas (SDH) during the same period. Four patients (100% male) ranging in age from 8.9 to 27.1 months (mean = 13.88) with pseudomeningocele and 17 patients (64.7% male) ranging in age from 1.9 to 11.8 months (mean = 4.15) with SDH were identified. Although the initial management included sequential percutaneous subdural tapping in 82% of the patients, all children ultimately failed such strategy, requiring either subdural-peritoneal (81% of the cases) or subgaleal-peritoneal (19% of the cases) shunting. The mean implant duration was 201 days for the pseudomeningocele group and 384 days for the SDH one. Mean post-shunt hospitalization was 2 days for patients with pseudomeningocele and 4 days for patients with SDH. There was no statistical difference in terms of complications, length of hospitalization post-shunting, or clinical outcomes between the patients with pseudomeningocele and those with SDH. Temporary shunting of infants with pseudo-meningocele constitutes a viable therapeutic alternative with favorable clinical outcomes and a low risk of shunt dependency similar to those of children with SDH.

慢性硬膜下血腫に対する経皮的硬膜下穿刺での血腫初圧と再発率

慢性硬膜下血腫に対する経皮的硬膜下穿刺での血腫初圧と再発率

A new simple therapeutic method for chronic subdural hematoma without irrigation and drainage

We developed a new simple therapeutic method for the treatment of chronic subdural hematoma (CSDH) without irrigation and drainage. This method is characterized by replacement of the hematoma with oxygen. Seventy patients (seventy-eight sides) with CSDH were treated with this method from May 1994 to October 2002. For the complete replacement of the hematoma with oxygen, subdural tapping site was changed from the thickest area of the hematoma to the parietal tuber. Irrigation and drainage were not used in all patients. Neurological recovery after the treatment was satisfactory in all 70 patients. An average amount of replaced hematoma was 96.1 ml, ranging from 5 to 280 ml. An initial hematoma pressure ranged from 0 to 200 mm H2O (average: 92.1 mm H2O). During the follow up periods, clinical recurrence was noted in 7 patients (10%) and 7 sides (9.0%). The replacement of the hematoma with oxygen via percutaneous subdural tapping without irrigation and drainage is useful and less invasive method for the treatment of CSDH.

Percutaneous Subdural Tapping and Subdural Peritoneal Drainage for the Treatment of Subdural Hematoma

Different therapeutic approaches may be used in the treatment of chronic subdural hematoma because it is more fluid. Age-dependent characteristics of the calvarium allow for different treatment in children and adults. Treatment options are discussed.

Prospective analysis of bedside percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults

OBJECTIVESAlthough there is general agreement that surgery is the best treatment for chronic subdural haematoma (CSDH), the extent of the surgical intervention is not well defined.METHODSThe less invasive surgical technique...

Acute epidural hematoma developing during twist-drill craniostomy: a complication of percutaneous subdural tapping for the treatment of chronic subdural hematoma

BACKGROUND This case illustrates that although percutaneous subdural tapping for patients with chronic subdural hematoma (CSDH) is successful and minimally invasive, it can be complicated by acute epidural hematoma. CASE PRESENTATION A 62-year-old woman presented with headache two months after minor head trauma. Computed tomography (CT) scanning revealed CSDH with mixed density on the right side. Prior to percutaneous subdural tapping, twist-drill craniostomy was performed at the parietal tuber. When the drill-needle reached the dura mater, the patient began to complain of headache, which was followed by altered consciousness. CT scanning disclosed acute epidural hematoma abutting the CSDH; both hematomas were evacuated by emergency craniotomy. At surgery, no definite bleeding source was identified apart from oozing on the dura mater. CONCLUSION Hemorrhagic complications after percutaneous subdural tapping are rare. The formation of acute epidural hematoma during twist-drill craniostomy has not been reported in the literature. This complication can occur when the blunt tip of the drill-needle remains on the dura mater without penetrating into the subdural hematoma cavity.

Percutaneous Subdural Tapping for the Treatment of Chronic Subdural Hematoma associated with Coagulopathy due to Advanced Cancer : Case Report

Percutaneous Subdural Tapping for the Treatment of Chronic Subdural Hematoma associated with Coagulopathy due to Advanced Cancer : Case Report

Computed tomography features immediately after replacement of haematoma with oxygen through percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults.

In an effort to achieve a simple and less invasive method for the treatment of chronic subdural haematoma, replacement of the haematoma with oxygen by percutaneous subdural tapping was employed in 36 patients. This study was conducted on 23 haematomas in 20 patients, whose computed tomography (CT) scans immediately following the treatment were available for evaluation, with particular regard to distinguishing between their findings and those seen with tension pneumocephalus. The CT features were divided into two patterns according to the location of oxygen; a convexity type (19 haematomas) and an interhemispheric type (4 haematomas). Analysis of the CT appearances revealed the oxygen was exclusively confined to the haematoma cavity, distinguishing it from the findings in tension pneumocephalus. This observation indicates the safety of replacement of the haematoma with oxygen when combined with our percutaneous subdural tapping technique which prevents lesions of the inner haematoma membrane.

A new therapeutic method for chronic subdural hematoma in adults: Replacement of the hematoma with oxygen via percutaneous subdural tapping

Seeking radical removal of chronic subdural hematoma using a simple and less invasive procedure, the author has devised a new method—replacement of the hematoma with oxygen via percutaneous subdural tapping. In this study, 40 patients were treated with this procedure. All patients made a full recovery after the treatment, without complications related to replacement of the hematoma with oxygen. Follow-up investigation showed recurrence of the lesion in two patients (5%). Because of its simplicity, reduced invasiveness, and short hospitalization, the procedure presented here is acceptable as an optimal therapeutic modality for chronic subdural hematoma in adults. Theoretical considerations supporting the safety of this procedure are discussed

Acute subdural haematoma successfully treated by percutaneous subdural tapping in an elderly patient

An elderly patient suffering acute subdural haematoma associated with cerebral contusion was treated by percutaneous subdural tapping while preparing for craniotomy. Most of the subdural haematoma, though of high density on computed tomography scanning, proved to be semiliquid. Drainage of the haematoma yielded resolution of the mass effect, and was followed by a rapid improvement of consciousness. This observation suggests the significance of trial subdural tapping for the treatment of acute traumatic subdural haematoma prior to craniotomy.

Chronic subdural hematoma in infancy

The cases of 30 infants with chronic subdural hematoma treated surgically between 1978 and 1987 (after the introduction of computerized tomography) were reviewed. This series was limited to infants presenting with increased intracranial pressure, neurological deficits, or developmental retardation. Nineteen patients were male and 11 were female, ranging in age from 1 to 14 months (average 6.1 months). The surgical treatment was initiated with percutaneous subdural tapping which was repeated periodically, if indicated, for 2 weeks. If the patients failed to respond to subdural tapping, subdural-peritoneal shunting was installed. The follow-up periods were from 3 months to 9 years 8 months (average 4 years 10 months). Computerized tomography at that time disclosed disappearance or minimal collection of subdural fluid in 28 cases (93%) and a significant collection (greater than 5 mm) in two (7%). Neurological examination revealed that the patients were "normal" in 17 cases (57%), "mildly or moderately disabled" in nine (30%), and "severely disabled" in four (13%). The majority of disabled patients had lesions secondary to infantile acute subdural hematoma, child abuse, or hemorrhagic diathesis. These results indicate that the treatment protocol in the present series is acceptable for the elimination of subdural hematoma. Together, early diagnosis and treatment of the etiological conditions causing the lesion are indispensable for obtaining a satisfactory neurological outcome.

Percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults.

Chronic subdural haematoma in adults has been treated by percutaneous subdural tapping using a subdural needle. In order to prevent recurrence, the procedure including replacement of the haematoma with oxygen, irrigation using relatively small amounts of saline, and additional drainage for one hour proved to be simple and reliable. The detailed technique is illustrated, and sequential computed tomography scans in six patients treated with this procedure are presented.