Surgery For Hematoma Research Articles

192 Craniotomy for Acute Subdural Hematoma-Outcomes in Patients Over 70 years

Abstract INTRODUCTION The mortality rate for elderly patients with surgery for acute subdural hematoma (aSDH) has been reported to be as high as 90%, but with the possibility of functional survivors, surgery is still frequently performed. Therefore, we examined our outcomes for patients 70 years and older who underwent craniotomy for aSDH. METHODS We retrospectively reviewed patients 70 years and older who had an open surgical intervention for aSDH between 2006 and 2016 at Memorial Hermann Hospital in Houston, Texas. A multivariable analysis of the clinical data and outcomes was then performed. RESULTS >Of the 112 patients reviewed, 95% sustained their injuries after a fall from standing. The mortality rate was 42%, but 24% of patients were discharged to home or to a rehabilitation facility. Multivariable analysis demonstrated that age, preexisting dementia, and surgery type had significant impact on outcome. Specifically, patient who were older than 80 years of age, had dementia or Parkinson's disease, or who required decompressive craniectomy (as opposed to craniotomy) had a worse outcome. CONCLUSION Elderly patients with aSDH requiring surgery have a high likelihood of death or significant disability. It is important to note that the mortality rate for large aSDHs is higher given that some patients with this disease were not deemed to be surgical candidates and therefore were not included in this study. However, up to one quarter of surgical patients will be functional enough to go home or to a rehabilitation facility from the hospital. The data suggest that age over 80 years old, dementia, or cerebral edema significant enough to warrant decompressive craniectomy are associated with an increased risk of death.

Neuro-Endoscopic Surgery for Multi-Lobular Chronic Subdural Hematoma

Chronic subdural hematoma(CSDH)generally occurs in the elderly, and is usually treated by burr-hole craniotomy with closed-system drainage. Treatment of recurrent CSDH is more challenging, especially when the hematoma is multi-lobular. A variety of approaches to the management of multi-lobular CSDH have been described, including evacuation through a wide craniotomy, placement of an Ommaya reservoir, subdural peritoneal shunting, and embolization of the middle meningeal artery. We have previously reported a method of evacuating multi-lobular CSDH through a small craniotomy using a rigid endoscope and aspiration tube. The objective of this study was to compare our operative method with others from the literature. Between January 2012 and October 2016, eight patients diagnosed with multi-lobular CSDH using computed tomography(CT)imaging underwent endoscopic evacuation. First, we established a 3×3cm craniotomy at a position where a rigid endoscope and aspiration tube would be able to reach as much of the hematoma cavity as possible in the longitudinal plane. Second, after identifying and removing the outer membrane of the CSDH with the scope, we evacuated the hematoma longitudinally, keeping the inner membrane intact. We also applied monopolar diathermy to any obvious bleeding points and the capillary network on the outer membrane of the CSDH, using the aspiration tube. The mean duration of surgery was 42 minutes. Follow-up CT scan revealed no recurrence in any of the cases, and neurologic function improved in all patients postoperatively. A multi-lobular CSDH can be drained quickly and effectively using a rigid endoscope and aspiration tube through a small craniotomy. In a cohort of eight patients, postoperative neurologic recovery was observed in all cases with no evidence of recurrence. This technique could be used in any facility with ready access to CT imaging and a rigid endoscope.

Surgical treatment for spinal dural arteriovenous fistulas: Outcome, complications and prognostic factors

Background and purposeSpinal dural arteriovenous fistulas (SDAVFs) are rare, acquired pathology and they inevitably lead to severe disability if untreated. The aim of this study is to present the outcome and complications, and to find factors that may affect the outcome after surgical treatment. MethodsSeventeen consecutive patients (men – 14, women – 3, age: 41–79) were retrospectively analyzed. The patients presented with paraparesis (88%), bladder symptoms (71%) and/or sensory disturbances (65%). The fistula was found in the upper thoracic spine in 2 cases, in the lower thoracic (T7–Th12) in 11 cases, and in the lumbar spine in 4 cases. Microsurgical shunt interruption was performed in all, followed by epidural arteries coagulation in 12 cases. ResultsIn the long term, improvement or achievement of a good stable condition was observed in 13 patients (76%), and no patient deteriorated. All 5 paraplegic patients improved by at least 1 grade in MCS. Satisfactory results (modified McCormick Scale grades I–II) were found in 10 patients (59%), and 15(88%) were independent. Postoperative complications occurred in 4 patients (24%), two of them (12%) required revision surgery for epidural hematoma. The success rate was 94%; one patient required revision surgery for recurrent SDAVF. Better neurological condition on admission (p=0.0098) and age >60 years (p=0.0498) were the factors associated with satisfactory outcome. ConclusionsMicrosurgical closing of a SDAVF brings good and stable results over time. Aggressive treatment should be attempted even in cases of total loss of spinal cord function. Neurological condition before surgery and age may influence the outcome.

Epidemiology and Estimated Cost of Surgery for Chronic Subdural Hematoma Conducted by the Unified Health System in Brazil (2008–2016)

Introduction Chronic subdural hematoma (CSH) is one of the most frequent forms of intracranial hemorrhage. It is a collection of encapsulated, well-delimited fluid and/or coagulated blood in several clotting stages located between the dura mater and the arachnoid mater. Objective To describe the epidemiological aspects of CSH described in the database of the Brazilian Unified Health System (SUS, in the Portuguese acronym) regarding admission numbers, hospitalization expenses, health care professional expenses, mortality rate, and death numbers by region from 2008 to the first half of 2016. Methods The present work was performed between August and September 2016 with a review about the epidemiological aspects of CSH in Brazil according to the Informatics Department of the Unified Health System (DATASUS) database, encompassing the period from January 2008 to June 2016, and to scientific papers from the past 10 years which were electronically published at the PubMed, Scielo, and LILACS databases. Results From 2008 to the first half of 2016, the total values were the following: hospital admission authorizations (HAAs). 33,878; hospital expenses, BRL 65,909,429.22; health care professional expenses, BRL 25,158,683.21; deaths, 2,758; and mortality rates ranging from 6.47 to 12.63%. Conclusion In spite of the high clinical relevance of CSH, epidemiological studies about this condition are limited. As such, the present paper is an updated approach on CSH, focusing on its epidemiological aspects according to the DATASUS database.

Surgery for chronic subdural hematoma in nonagenarians: A Scandinavian population-based multicenter study.

Chronic subdural hematoma (cSDH) is a prevalent condition often seen in the elderly, with surgery being the treatment of choice when symptomatic. So far, few have explored the surgical outcomes in patients 90years or older. The aim of this study was to investigate outcome after cSDH surgery in nonagenarians (≥90 y/o group) compared to younger adult patients (<90 y/o group). In a Scandinavian population-based cohort we conducted a retrospective review of 1,254 patients undergoing primary burr-hole procedures for cSDH between January 1, 2005 and December 31, 2010 at three neurosurgical centers. In a comparative analysis, the primary end-point was difference in hematoma recurrence rates between the ≥90 y/o and <90 y/o groups. The secondary end-points were differences in perioperative morbidity and mortality between groups. 75 patients were 90years or older. There was no significant difference in recurrences resulting in reoperation between the age groups (10.7% vs 13.6%, P=.47). There was also no significant difference in overall complication rate (4.1% vs 8.1%, P=.21) or severe complications (1.4% vs 2.0%, P=.68). There were three (4.0%) perioperative deaths within 30days in the ≥90 y/o group and 40 (3.4%) in the <90 y/o group (P=.78). Patients 90years or older had similar rates of recurrence, perioperative morbidity and perioperative mortality as compared to younger patients. Age alone should not be a contraindication for surgery in patients with cSDH.

Clinical Course and Results of Surgery for Chronic Subdural Hematomas in Patients on Drugs Affecting Hemostasis.

ObjectiveAn apparent increase of use of drugs affecting hemostasis in our neurosurgical department since the 1990s has encouraged us to investigate whether these drugs influence the clinical course and results of surgery for chronic subdural hematoma (CSDH).MethodsThis retrospective analysis included 178 patients admitted for CSDH from 2007 to 2011 who were divided into two groups: on drugs affecting hemostasis (40; 22%) and no bleeding disorders (138; 78%). Medications in the first group included oral anticoagulants (33; 82.5%), antiplatelets (5; 12.5%) and low molecular weight heparins (2; 5%).ResultsThe patients on drugs affecting hemostasis were older (74.3±7.4 vs. 68.4±14.8; p-value 0.01) and the group without bleeding disorders had more head trauma history (61% vs. 38%, p-value 0.01). The groups did not differ in bilateral hematoma rates (25% vs. 20%, p-value=NS). At diagnosis, mean hematoma thickness was lower in patients on drugs affecting hemostasis (18.7±7.4 mm vs. 21.9±7.9 mm, p-value<0.01). Average stay of hospital was 1 day longer in patients on drugs affecting hemostasis (11.7±4.1 vs.10.9±5.3, p-value=NS) and was related to the necessity of bleeding disorder reversal. Mean neurological status at presentation was similar between the groups (p-value=NS) as was the likelihood of hematoma recurrence (p-value=NS). Glasgow Outcome Scale results were comparable.ConclusionPatients on drugs affecting hemostasis are less often aware of a head trauma history, possibly suggesting a higher CSDH risk after minor trauma in this group. In these patients, smaller hematomas are symptomatic, probably due to faster hematoma formation. Drugs affecting hemostasis do not affect treatment results.

Long-term follow-up for ossification of autologous bone plug and skin sinking after periosteum-preserved burr hole surgery.

Background:The demand of a burr hole surgery for chronic subdural hematoma (CSDH) is increasing in the global aging society. Burr hole-derived autologous bone dusts are not associated with extra costs compared with other commonly used synthetic materials. In addition, postoperative calvarium ossification requires periosteum-mediated blood supply, which is lacking after using avascular synthetic materials. Based on these findings, we hypothesized that the combination of the bone plugs and the preserved periosteum during burr hole surgeries for CSDH would induce efficient calvarium ossification.Methods:We evaluated the long-term effects of bone plugs on the degree of ossification and cosmetic appearance of the skin covering the burr hole sites. We included 8 patients (9 burr holes) who received the autologous bone dust derived from burr holes. As the control group, 9 burr holes that did not receive any burr hole plugs were retrospectively selected. These burr holes were evaluated by computed tomography (CT) scan for the calvarium defect ratios, CT value-based ossification, and the degree of skin sinking.Results:Ossification was observed in all the bone plugs by the bone density CT scans; they maintained their volume at 12 months after the surgeries. The calvarium defect ratios (volume ratios of the unossified parts in the burr holes) gradually increased during the first 6 months and reached 0.44 at 12 months. The mean CT values also increased from 527 HU to 750 HU for the first 6 months and reached 905 HU at 12 months. The degrees of skin sinking at the burr hole sites with the bone plugs were 1.24 mm whereas those without the bone plugs were 2.69 mm (P = 0.004).Conclusion:Application of burr hole-derived autologous bone dust is associated with better ossification and objective cosmetic result following burr hole surgery after CSDH.

Clinical Features and Outcomes of Bilateral Decompression Surgery for Immediate Contralateral Hematoma after Craniectomy Following Acute Subdural Hematoma.

ObjectiveImmediate contralateral epidural hematoma (EDH) and traumatic intracerebral hematoma (T-ICH) after craniectomy for traumatic subdural hematoma (SDH) are rare but devastating post-operative complications. Their clinical features and outcomes are not well studied. In this report, we present the clinical features and outcomes of immediate contralateral acute hematoma cases requiring a second operation.MethodsThis study includes 10 cases of immediate contralateral EDH and T-ICH following bilateral craniectomy for the evacuation of traumatic SDH and contralateral hematoma between 2004 and 2015. Their medical records and radiographic findings were reviewed and analyzed retrospectively.ResultsTen of the 528 patients (1.89%) who underwent craniectomy for the evacuation of traumatic SDH developed post-operative EDH (n=5), T-ICH (n=5). The trauma was caused by a fall in 5 patients and by a traffic accident in 5 patients. The patients who suffered trauma due to pedestrian accidents died. Seven patients had a low admission Glasgow Coma Scale (GCS; GCS≤8) score in the preoperative state (average admission GCS, 7.7; average discharge GCS, 3.4; and average discharge Glasgow Outcome Scale, 2.0). Severe intra-operative brain swelling was noted in all patients, while skull fracture was observed in 8. Multiple associated injuries and medication for heart disease were characteristic of patients who died.ConclusionThe prognosis of delayed contralateral hematoma was very poor. Multiple associated injuries, past medical history and traffic accidents, especially pedestrians were seemed to be associated with higher mortality rates. Finally, contralateral skull fractures can indicate high risk of delayed contralateral acute intracranial hematoma.

Evaluation of Cortical Brain Parenchyma by Diffusion and Perfusion MRI Before and After Chronic Subdural Hematoma Surgery.

To evaluate microcirculatory changes in neighboring parenchyma as a result of pressure due to chronic subdural hematoma (CSDH) in early and late periods after hematoma drainage. The subject group consisted of 25 patients who underwent CSDH drainage. Brain diffusion and perfusion magnetic resonance images (MRIs) were obtained preoperatively, and at 48 hours (early period) and 2 months (late period) postoperatively. Measurements were performed on 1 cm2 regions of interest (ROI) in the neighboring parenchymal tissue. The early postoperative diffusion values showed improvement compared to the preoperative values. The late postoperative values showed improvement compared to the preoperative and early postoperative values. The early postoperative perfusion values showed slight decline compared to the preoperative values. However, the late postoperative values showed improvement compared to the preoperative and early postoperative values. The fact that there was an increase in diffusion values from early to late postoperative periods, compared with the preoperative period, indicates that the beneficial effects of surgery increase over time. Brain perfusion was found to be slightly decreased in early postoperative period. Following CSDH drainage, neurological deteriorations are observed in some patients in the early postoperative periods; a slight impairment in perfusion may account for this. However, during the late postoperative period, perfusion was seen to recover prominently.

The Safety and Efficacy of Dexmedetomidine vs. Sufentanil in Monitored Anesthesia Care during Burr-Hole Surgery for Chronic Subdural Hematoma: A Retrospective Clinical Trial.

Background: Chronic subdural hematoma (CSDH) is a very common clinical emergency encountered in neurosurgery. While both general anesthesia (GA) and monitored anesthesia care (MAC) can be used during CSDH surgery, MAC is the preferred choice among surgeons. Further, while dexmedetomidine (DEX) is reportedly a safe and effective agent for many diagnostic and therapeutic procedures, there have been no trials to evaluate the safety and efficacy of DEX vs. sufentanil in CSDH surgery.Objective: To evaluate the safety and efficacy of DEX vs. sufentanil in MAC during burr-hole surgery for CSDH.Methods: In all, 215 fifteen patients underwent burr-hole surgery for CSDH with MAC and were divided into three groups: Group D1 (n = 67, DEX infusion at 0.5 μg·kg−1 for 10 min), Group D2 (n = 75, DEX infusion at 1 μg·kg−1 for 10 min), and Group S (n = 73, sufentanil infusion 0.3 μg·kg−1 for 10 min). Ramsay sedation scale (RSS) of all three groups was maintained at 3. Anesthesia onset time, total number of intraoperative patient movements, hemodynamics, total cumulative dose of DEX, time to first dose and amount of rescue midazolam or fentanyl, percentage of patients converted to alternative sedative or anesthetic therapy, postoperative recovery time, adverse events, and patient and surgeon satisfaction scores were recorded.Results: The anesthesia onset time was significantly less in group D2 (17.36 ± 4.23 vs. 13.42 ± 2.12 vs. 15.98 ± 4.58 min, respectively, for D1, D2, S; P < 0.001). More patients in groups D1 and S required rescue midazolam to achieve RSS = 3 (74.63 vs. 42.67 vs. 71.23%, respectively, for D1, D2, S; P < 0.001). However, the total dose of rescue midazolam was significantly higher in group D1 (2.8 ± 0.3 vs. 1.9 ± 0.3 vs. 2.0 ± 0.4 mg, respectively, for D1, D2, S; P < 0.001). The time to first dose of rescue midazolam was significantly longer in group D2 (17.32 ± 4.47 vs. 23.56 ± 5.36 vs. 16.55 ± 4.91 min, respectively, for D1, D2, S; P < 0.001). Significantly fewer patients in groups S and D2 required rescue fentanyl to relieve pain (62.69 vs. 21.33 vs. 27.40%, respectively, for D1, D2, S; P < 0.001). Additionally, total dose of rescue fentanyl in group D1 group was significantly higher (212.5 ± 43.6 vs. 107.2 ± 35.9 vs. 98.6 ± 32.2 μg, respectively, for D1, D2, S; P < 0.001). Total number of patient movements during the burr-hole surgery was higher in groups D1 and S (47.76 vs. 20.00 vs. 47.95%, respectively, for D1, D2, S; P < 0.001). Four patients in D1 and five in S converted to propofol. The time to recovery for discharge from the PACU was significantly shorter in group D2 (16.24 ± 4.15 vs. 12.48 ± 3.29 vs. 15.91 ± 3.66 min, respectively, for D1, D2, S; P < 0.001). Results from the patient and surgeon satisfaction scores showed significant differences favoring group D2 (P < 0.05). More patients in groups D1 and S showed higher levels of the overall incidence of tachycardia and hypertension, and required higher doses of urapidil and esmolol (P < 0.05). Six patients experienced respiratory depression in group S.Conclusion: Compared with sufentanil, DEX infusion at 1 μg·kg−1 was associated with fewer intraoperative patient movements, fewer rescue interventions, faster postoperative recovery, and better patient and surgeon satisfaction scores and could be safely and effectively used for MAC during burr-hole surgery for CSDH.

Follow-up after surgery for hemorrhagic AMD

The long-term functional results of macular hematoma (MH) surgery in exudative AMD are often limited. The goal of this study was to compare visual outcomes of monthly versus bimestrial follow-up in these patients. Retrospective, interventional case series. Population: 21eyes of 21patients with SMH associated with exudative AMD. first SMH associated with exudative AMD, with 1-year postoperative follow-up. blood located exclusively underneath the retinal pigment epithelium on OCT imaging, SMH due to different etiology, lost to follow-up, ≤5postoperative visits and a different surgical protocol as described. Patients were divided into two groups according to the number of postoperative visits (number of intravitreal injections [IVT] combined with the number of consultations, only one visit was recorded when IVT and consultation occurred on the same day) during the 1-year postoperative follow-up: group1 had ≥11visits (n=8); group2 had 6 to 10visits (n=13). All eyes underwent vitrectomy with subretinal injection of recombinant tissue plasminogen activator, fluid-gas exchange and anti-VEGF intravitreal injection. The main outcome was change in best-corrected visual acuity (BCVA). Considering visual acuity (VA) change between 1-month and 1-year postoperative follow-up examinations, group1 had statistically significant greater VA changes (logMAR -0.29±0.44 vs logMAR 0.42±0.73; P=0.016; P=0.016). In patients that had exudative recurrences (ER), group1 received more anti-VEGF IVT than group2 (P=0.045). Our results showed that monthly follow-up, between the IVT series, is highly recommended to preserve postoperative VA in patients undergoing surgery for SMH associated with AMD.

Predictors for outcome after surgery for traumatic acute subdural hematoma

Abstract Introduction: Acute traumatic subdural hematoma (ASDH) is one of the most frequent conditions in neurosurgery demanding emergency surgery. The aim of the study was to identify factors influencing outcome in patients who had surgery for evacuation of ASDH. Methods: From 2005 to 2012 eighty-five patients at age above 18 years had surgery for evacuation of ASDH. Outcome was measured according GOS at discharge and was dichotomized as “favorable outcome” (GOS 4 to 5) and “unfavorable outcome” (GOS 1 to 3). These factors were evaluated with univariate and logistic regression analysis for significance with outcome. Results: The mean age of the 85 patients was 62.7 years (SD±18.5). 45.9% patients were with favorable outcome and 54.1% had unfavorable outcome. Patients with GCS score 3-8 (54.1%) had 80.4% unfavorable outcome whereas 78.6% of patients with GCS score 13-15 (32.9%) had favorable outcome. All patients with nonreactive pupils (bilaterally or unilaterally - 31.8%) had unfavorable outcome whereas patients (36.5%) with both reactive pupils (36.5%) had in 80.6% favorable outcome. All patients (40%) with Rotterdam CT scores 5 and 6 had unfavorable outcome. The factors determining outcome were admission GSC score, Rotterdam CT scores, and prothrombin time. Conclusion: Patients who have GSC score of 3, unresponsive pupil(s) or have Rotterdam CT scores 5 and 6 have little chance of survival. Patients with coagulopathy have two times more unfavorable outcome. The patients with ASDH should have surgery as soon as possible after correction of vital parameters in order to avoid deterioration which can be very rapid and irreversible.

The Bone Flap Dilemma in Acute Subdural Hematoma Surgery

The Bone Flap Dilemma in Acute Subdural Hematoma Surgery

Is systematic post-operative CT scan indicated after chronic subdural hematoma surgery? A case-control study.

The aim of the present study was to evaluate the interest of systematic post-operative CT scan after unilateral chronic subdural hematoma (CSDH) evacuation. To achieve this goal, we chose to evaluate the ability of post-operative CT scan to predict the most frequent complication of CSDH: hematoma recurrence. We performed a retrospective case-control study. Cases were defined as patients who had CSDH recurrence; controls were those who did not. We first studied clinical data and pre-operative CT scan data. We then studied post-operative CT scan data: hematoma thickness and its decrease, persistence of midline shift, its value and its decrease, and presence of compressive pneumocephalus. Among 654 patients, 15 were defined as cases, and were matched with 30 non-recurrent patients defined as controls. Regarding systematic post-operative CT scan findings, unilateral CSDH recurrence was clearly associated with the persistence of midline shift induced by the presence of compressive pneumocephalus. Systematic post-operative CT scan after unilateral CSDH evacuation could predict hematoma recurrence. We therefore considered it as recommended, to adapt the clinical and radiological follow-up of CSDH patients.

Subdural haematoma complicating shunting for normal pressure hydrocephalus in the setting of concomitant antiplatelet medication – a report of 11 cases

Objective: To report on the occurrence and management of subdural haematoma after shunt implantation for normal pressure hydrocephalus and to determine the risk of recurrence in the setting of antiplatelet medication. Methods: From a consecutive series of 80 patients implanted with a cerebrospinal fluid shunt for normal pressure hydrocephalus, records from 11 patients taking antiplatelet drugs, who subsequently had surgery for subdural haematoma were extracted and retrospectively reviewed. Results: Patients were followed up for a mean of 1819 days after shunt implantation. Subdural haematomas occurred at a median of 335 days after shunt implantation – four ipsilateral, five contralateral and two bilateral with respect to the ventricular catheter. Three patients had reoperations done within a week without having resumed antiplatelet medication in the interim. One of them had three further reoperations done before the subdural collection disappeared. Only one patient had a late recurrence almost 11 years after shunt implantation. Conclusions: Subdural haematoma in the setting of a ventriculoperitoneal implantation for normal pressure hydrocephalus and concomitant antiplatelet medication can be managed along usual lines. Antiplatelet medication can be recommenced in due course with a low risk of recurrence.

Spontaneously developed paraplegia in a patient with Factor V Leiden mutation

Factor V Leiden (FVL) mutation is the one-point mutation in G1691A in the tenth exon of the gene for Factor V, caused by the substitution of glutamine for arginine at codon 506. We present here a patient with a mutation of the Factor V gene and taking anticoagulant therapy, who became paraplegic following surgery for dural hematoma and spontaneous spinal intramedullary hematoma. His physical examination revealed T5 ASIA A, complete paraplegia. Our case is important in the literature, as being the first case with spinal intramedullary hematoma that developed due to anticoagulant use.

Survival Trends After Surgery for Acute Subdural Hematoma in Adults Over a 20-year Period.

Objective:We sought to determine 30-day survival trends and prognostic factors following surgery for acute subdural hematomas (ASDHs) in England and Wales over a 20-year period.Summary of Background Data:ASDHs are still considered the most lethal type of traumatic brain injury. It remains unclear whether the adjusted odds of survival have improved significantly over time.Methods:Using the Trauma Audit and Research Network (TARN) database, we analyzed ASDH cases in the adult population (>16 yrs) treated surgically between 1994 and 2013. Two thousand four hundred ninety-eight eligible cases were identified. Univariable and multiple logistic regression analyses were performed, using multiple imputation for missing data.Results:The cohort was 74% male with a median age of 48.9 years. Over half of patients were comatose at presentation (53%). Mechanism of injury was due to a fall (<2 m 34%, >2 m 24%), road traffic collision (25%), and other (17%). Thirty-six per cent of patients presented with polytrauma. Gross survival increased from 59% in 1994 to 1998 to 73% in 2009 to 2013. Under multivariable analysis, variables independently associated with survival were year of injury, Glasgow Coma Scale, Injury Severity Score, age, and pupil reactivity. The time interval from injury to craniotomy and direct admission to a neurosurgical unit were not found to be significant prognostic factors.Conclusions:A significant improvement in survival over the last 20 years was observed after controlling for multiple prognostic factors. Prospective trials and cohort studies are expected to elucidate the distribution of functional outcome in survivors.

Minimally invasive surgery for ICH evacuation followed by rosiglitazone infusion therapy increased perihematomal PPARγ expression and improved neurological outcomes in rabbits

Objectives: To observe the effects of minimally invasive surgery (MIS) for intracerebral hematoma (ICH) evacuation followed by rosiglitazone infusion therapy on peroxisome proliferator-activated receptor-gamma (PPARγ), blood–brain barrier (BBB) permeability, and neurological function.Methods: A total of 75 male rabbits (2.8–3.4 kg) were randomly assigned to a normal control group (NC group), a model control group (MC group), a rosiglitazone group (RSG group), a minimally invasive treatment group (MIS group) or a MIS combined with rosiglitazone group (MIS+RSG group). ICH was induced in all of the animals except for those in the NC group. The rosiglitazone was infused into the hematoma area in the RSG group and the MIS+RSG group. A MIS was performed to evacuate the ICH 6 h after the successful preparation of the ICH model in the MIS group and the MIS+RSG group. Each group included 15 rabbits and was divided equally into 3 subgroups (each subgroup included 5 rabbits that were killed on day 1, day 3, or day 7). Neurological deficit scores were determined, and the perihematomal brain tissue was removed to determine the PPARγ level and BBB permeability.Results: Neurological deficit scores, perihematomal PPARγ levels, and BBB permeability were all significantly increased in the MC group compared to the NC group. Performing the MIS alone to evacuate the ICH resulted in a marked decrease in these indices. The RSG used alone increased PPARγ levels and decreased BBB disruption. The MIS+RSG group displayed a marked increase in PPARγ levels and a more significant decrease in BBB permeability and neurological deficit scores.Conclusions: Performing MIS followed by PPARγ agonist infusion therapy is more efficacious for reducing secondary damage to the brain and improving neurological function.

Abstract WP365: Role of Enhanced CT Findings in Endoscopic Surgery for Intracerebral Hematoma

Objective: In our institute, endoscopic aspiration of hematoma is often performed for acute treatment of intracerebral hematoma (ICH). In some cases, hemostasis is technically difficult to perform during endoscopy, and post-operative hemorrhage may occur. We examined the association between perioperative complications associated with endoscopic surgery for acute ICH, and radiological findings on enhanced computed tomography (CT). Methods: Subjects were 471 patients diagnosed with hypertensive ICH who had been admitted and treated in our institute within 72 hours from onset, between 2012 and 2015. Enhanced CT imaging was performed at admission, and radiological enhancement signs (RES) were defined as CT angiography spot signs in the arterial phase, or contrast extravasation in the parallel phase. RES-positive subjects were grouped and compared with an equal number of RES-negative subjects, and the association between perioperative complications and RES was analyzed. Results: The RES-positive group included 39 subjects; endoscopic surgery was performed in 16 of the 39 subjects. Postoperative hemorrhage occurred in 6 of the 16 subjects. No hemorrhagic complications were found in the RES-negative group. Follow-up CT after 24 hours showed hematoma expansion in 20 of 26 subjects in the RES-positive group and in only 1 of the 39 subjects of the RES-negative group. Statistical analyses showed that the RES-positive group had a significantly shorter duration between the onset of ICH and CT scan and significantly larger hematoma volume, compared with the RES-negative group. Multivariate analysis identified the presence of RES as a significant risk factor of postoperative hemorrhage or hematoma expansion on follow-up CT. Conclusion: CT angiography spot signs or contrast extravasation positive signs were observed with a shorter duration between ICH onset and CT scan, and larger hematomas. These signs may be an important predictive factor for hematoma expansion, as well as a significant risk factor of postoperative hemorrhage after endoscopic surgery for ICH.

Examination of cases complicated by intracranial hemorrhage after burr-hole surgery for chronic subdural hematoma

Examination of cases complicated by intracranial hemorrhage after burr-hole surgery for chronic subdural hematoma