scholarly journals Simultaneous Cranioplasty and Subdural-Peritoneal Shunting for Contralateral Symptomatic Subdural Hygroma following Decompressive Craniectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Muh-Shi Lin ◽  
Tzu-Hsuan Chen ◽  
Woon-Man Kung ◽  
Shuo-Tsung Chen
Keyword(s):  
Decompressive Craniectomy ◽  
Surgical Intervention ◽  
Muscle Power ◽  
Neurological Deficits ◽  
Fluid Circulation ◽  
Subdural Hygroma ◽  
Cerebrospinal Fluid Circulation ◽  
Excellent Outcome ◽  
Cerebral Herniation ◽  
Computed Tomography Scans

Background.Contralateral subdural hygroma caused by decompressive craniectomy tends to combine with external cerebral herniation, causing neurological deficits.Material and Methods.Nine patients who underwent one-stage, simultaneous cranioplasty and contralateral subdural-peritoneal shunting were included in this study. Clinical outcome was assessed by Glasgow Outcome Scale as well as Glasgow Coma Scale, muscle power scoring system, and complications.Results.Postoperative computed tomography scans demonstrated completely resolved subdural hygroma and reversed midline shifts, indicating excellent outcome. Among these 9 patients, 4 patients (44%) had improved GOS following the proposed surgery. Four out of 4 patients with lethargy became alert and orientated following surgical intervention. Muscle strength improved significantly 5 months after surgery in 7 out of 7 patients with weakness. Two out of 9 patients presented with drowsiness due to hydrocephalus at an average time of 65 days after surgery. Double gradient shunting is useful to eliminate the respective hydrocephalus and contralateral subdural hygroma.Conclusion.The described surgical technique is effective in treating symptomatic contralateral subdural hygroma following decompressive craniectomy and is associated with an excellent structural and functional outcome. However, subdural-peritoneal shunting plus cranioplasty thoroughly resolves the subdural hygroma collection, which might deteriorate the cerebrospinal fluid circulation, leading to hydrocephalus.

scholarly journals Comparison of the Efficacy of Standard Decompressive Craniectomy Combined with Cerebrospinal Fluid Circulation Reconstruction in the Treatment of Severe Craniocerebral Injury

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Zhanqing Han ◽  
Jianbin Sun ◽  
Jingyang Zhong
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Decompressive Craniectomy ◽  
Operation Time ◽  
Control Group ◽  
Craniocerebral Injury ◽  
Fluid Circulation ◽  
Cerebrospinal Fluid Circulation ◽  
Significant Difference ◽  
Experimental Group

Abstract： Objective: To observe and discuss the clinical effect of standard decompressive craniectomy combined with cerebrospinal fluid circulation reconstruction in the treatment of severe craniocerebral injury. Methods: Seventy patients who underwent surgery in our hospital were selected as subjects for this study. The time was from August 2016 to August 2018, and patients were divided into experimental group (35 cases) and control group (35 cases) according to the random number table method. The control group was treated with a single standard decompressive craniectomy according to clinical symptoms. The experimental group was treated with standard decompressive craniectomy combined with cerebrospinal fluid circulation reconstruction. The surgical treatment effect, GCS (Glasgow Coma Scale) score and operation time were compared between the two groups. Results: After comparison, the surgical treatment effect of the experimental group was higher than that of the control group and there was a significant difference between the two groups (P<0.05). The GCS score and operation time of the experimental group were also better than of the control group and there was a significant difference the two groups (P<0.05). Conclusion: The use of standard decompressive craniectomy combined with cerebrospinal fluid circulation reconstruction in the treatment of severe craniocerebral injury is more effective and worthy of widespread promotion and application.

scholarly journals Simultaneous Cranioplasty and External Ventricular Drain Implantation in Patients with Hydrocephalus: Case Series and Literature Review

2021 ◽  
Author(s):  
Lívio Pereira de Macêdo ◽  
Arlindo Ugulino Netto ◽  
Kauê Franke ◽  
Pierre Vansant Oliveira Eugenio ◽  
John Anderson da Silva Rocha ◽  
...  
Keyword(s):  
External Ventricular Drain ◽  
Neurological Complication ◽  
Case Series ◽  
Neurological Deficits ◽  
Time Interval ◽  
Automobile Accidents ◽  
Decompressive Hemicraniectomy ◽  
Cerebral Herniation ◽  
Intraoperative Period ◽  
The Brain

Abstract Introduction The increase in intracranial pressure (ICP) is a neurological complication resulting from numerous pathologies that affect the brain and its compartments. Therefore, decompressive craniectomy (DC) is an alternative adopted to reduce ICP in emergencies, especially in cases refractory to clinical therapies, in favor of patient survival. However, DC is associated with several complications, including hydrocephalus (HC). The present study presents the results of an unusual intervention to this complication: the implantation of an external ventricular drain (EVD) in the intraoperative period of cranioplasty (CP). Methods Patients of both genders who presented with HC and externalization of the brain through the cranial vault after decompressive hemicraniectomy and underwent EVD implantation, to allow the CP procedure, in the same surgical procedure, were included. Results Five patients underwent DC due to a refractory increase in ICP, due to automobile accidents, firearm projectiles, falls from stairs, and ischemic strokes. All evolved with HC. There was no uniform time interval between DC and CP. The cerebrospinal fluid (CSF) was drained according to the need for correction of cerebral herniation in each patient, before undergoing cranioplasty. All patients progressed well, without neurological deficits in the immediate postoperative period. Conclusion There are still several uncertainties about the management of HC resulting from DC. In this context, other CP strategies simultaneous to the drainage of CSF, not necessarily related to ventriculoperitoneal shunt (VPS), should be considered and evaluated more deeply, in view of the verification of efficacy in procedures of this scope, such as the EVD addressed in this study.

scholarly journals The orthopedic characterization of cfap298tm304 mutants validate zebrafish to faithfully model human AIS

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Marie-Hardy Laura ◽  
Cantaut-Belarif Yasmine ◽  
Pietton Raphaël ◽  
Slimani Lotfi ◽  
Pascal-Moussellard Hugues
Keyword(s):  
Cerebrospinal Fluid ◽  
Three Dimensional ◽  
Fluid Circulation ◽  
Micro Computed Tomography ◽  
Csf Flow ◽  
Cerebrospinal Fluid Circulation ◽  
Clinical Criteria ◽  
Brain And Spinal Cord ◽  
The Brain

AbstractCerebrospinal fluid (CSF) circulation relies on the beating of motile cilia projecting in the lumen of the brain and spinal cord cavities Mutations in genes involved in cilia motility disturb cerebrospinal fluid circulation and result in scoliosis-like deformities of the spine in juvenile zebrafish. However, these defects in spine alignment have not been validated with clinical criteria used to diagnose adolescent idiopathic scoliosis (AIS). The aim of this study was to describe, using orthopaedic criteria the spinal deformities of a zebrafish mutant model of AIS targeting a gene involved in cilia polarity and motility, cfap298tm304. The zebrafish mutant line cfap298tm304, exhibiting alteration of CSF flow due to defective cilia motility, was raised to the juvenile stage. The analysis of mutant animals was based on micro-computed tomography (micro-CT), which was conducted in a QUANTUM FX CALIPER, with a 59 µm-30 mm protocol. 63% of the cfap298tm304 zebrafish analyzed presented a three-dimensional deformity of the spine, that was evolutive during the juvenile phase, more frequent in females, with a right convexity, a rotational component and involving at least one dislocation. We confirm here that cfap298tm304 scoliotic individuals display a typical AIS phenotype, with orthopedic criteria mirroring patient’s diagnosis.

Advantages and limitations of the use of tractography and fMRI in the treatment of anaplastic glioma

2021 ◽  
pp. 32-42
Author(s):  
Igor Aleksandrovich Medyanik ◽  
Simon Quarteng Badu
Keyword(s):  
Neurological Disorders ◽  
Preoperative Diagnosis ◽  
Surgical Intervention ◽  
Complete Resection ◽  
Anaplastic Glioma ◽  
Neurological Deficits ◽  
Neural Pathways ◽  
Histological Subtype ◽  
Group A ◽  
Group B

The possibility of using only tractography as a preoperative diagnosis of anaplastic glioma is limited due to its inability to show the exact functional location of the tumor; therefore, the combination of tractography and fMRI seems to be a more promising complex diagnostic method. In neurooncology, complete resection without or with minimal neurological deficit is the goal of surgical intervention. The aim of the study was to investigate the advantages and limitations of the use of tractography and fMRI in the treatment of anaplastic glioma compared to standard CT or MRI. The study involved 48 patients who were divided into two groups based on the use of fMRI and tractography: group A (24 patients) and without it — group B (24 patients). The groups were compared in terms of age, sex, histological subtype of anaplastic glioma, degree of resection, postoperative complications, and dynamics of neurological disorders. The combination of fMRI and tractography is the best preoperative diagnosis, it is safe and allows localizing neural pathways, preserve them during surgery, and reduce postoperative neurological deficits.

scholarly journals Progressive Scoliosis and Syringomyelia - Questions of Surgical Approach

Folia Medica ◽  
2018 ◽  
Vol 60 (2) ◽  
pp. 261-269 ◽  
Author(s):  
Mikhail Mikhaylovskiy ◽  
Vyacheslav Stupak ◽  
Vadim Belozerov ◽  
Nikolay Fomichev ◽  
Anatoliy Lutsik ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Surgical Correction ◽  
Neurological Deficits ◽  
Spinal Deformities ◽  
Loss Of Correction ◽  
Scoliotic Deformity ◽  
Scoliosis Correction ◽  
The Moment ◽  
Comparison Of The Results

Abstract Background: The rate of scoliosis in syringomyelia patients ranges from 25 to 74.4%. In turn, syringomyelia occurs in 1.2% to 9.7% of scoliosis patients. Aim: To evaluate outcomes of surgical correction of the scoliotic deformity in syringomyelia patients. Materials and methods: Between 1996 and 2015, 3120 patients with scoliosis of various etiologies were treated at the Clinic for Child and Adolescent Vertebrology of the Novosibirsk Research Institute of Traumatology and Orthopedics. We conducted a retrospective analysis of syringomyelia-associated scoliosis cases that required surgical correction. Results: Syringomyelia was found in 33 patients (1.05%) out of 3120 patients with spinal deformities of various etiologies; in 21 patients (0.9%) with idiopathic scoliosis of 2334 patients. In identifying the neurological deficit, the recommended first step is to perform neurosurgery. Nineteen patients were operated using the CDI, 4 patients underwent correction VEPTR, in 1 case instrumentation could not be established, 9 patients are undergoing treatment in the department of neurosurgery at the moment. Worsening of neurological deficits was not observed in any patient. Conclusion: A comparison of the results of syringomyelia-associated scoliosis correction with the data of other authors was done. The choice of surgery tactics is strictly individual and depends on the size of the cavity. The result of surgical intervention is generally positive and the loss of correction by the end of follow-up is negligible.

scholarly journals A Case of Secondary Aortoesophageal Fistula Inserted a Covered Self-Expanding Esophageal Stent to Control Gastrointestinal Bleeding

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Makoto Onodera ◽  
Yoshihiro Inoue ◽  
Yasuhisa Fujino ◽  
Satoshi Kikuchi ◽  
Shigeatsu Endo
Keyword(s):  
High Risk ◽  
Surgical Intervention ◽  
Esophageal Stent ◽  
Aortoesophageal Fistula ◽  
Endovascular Stent Graft ◽  
Computed Tomography Scans ◽  
Feasible Option ◽  
Risk Patients ◽  
Stent Graft Repair ◽  
Endovascular Stent Graft Repair

A 73-year-old man presented with melena. After a thorough workup including esophageal endoscopy, computed tomography scans, and esophagography, the diagnosis of secondary aortoesophageal fistula was made. Two years previously, he had undergone endovascular stent-graft repair for the dissection of his descending thoracic aorta. Because of the generally poor condition of the patient and the high risk of any aggressive surgical intervention, we inserted a covered self-expanding esophageal stent on postadmission day 18. Esophagography after insertion did not show any evidence of a leak of contrast medium. Despite treatment with antibiotics, he developed sepsis and expired on day 52, but rebleeding did not occur in this period. We consider insertion of a covered self-expanding esophageal stent as a feasible option in the management of secondary aortoesophageal fistula in high-risk patients.

Experimental Studies Relating to Diagnostic Imaging in Disorders of Cerebrospinal Fluid Circulation

1980 ◽  
pp. 381-404 ◽  
Author(s):  
A. Everette James ◽  
Gary R. Novak ◽  
Ernst-Peter Strecker ◽  
Barry B. Burns ◽  
Francisco Correa-Paz ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Diagnostic Imaging ◽  
Experimental Studies ◽  
Fluid Circulation ◽  
Cerebrospinal Fluid Circulation

scholarly journals Prospective Randomized Evaluation of Decompressive Ipsilateral Craniectomy for Traumatic Acute Epidural Hematoma (PREDICT-AEDH): study protocol for a randomized controlled trial

2021 ◽  
Author(s):  
Chun Yang ◽  
Xianjian Huang ◽  
Junfeng Feng ◽  
Li Xie ◽  
Jiyuan Hui ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Decompressive Craniectomy ◽  
Epidural Hematoma ◽  
Controlled Trial ◽  
Economic Benefits ◽  
Brain Herniation ◽  
Post Injury ◽  
Randomized Controlled ◽  
Cerebral Herniation ◽  
Acute Epidural Hematoma

Abstract Background: Expeditiously surgical evacuation of acute epidural hematoma (AEDH) is an attainable gold standard and is often expected to have a good clinical outcome for patients with surgical indications. However, controversy exists on the optimal surgical treatment for AEDH, especially for patients with brain herniation. Neurosurgeons are confronted by the decision to evacuate the hematoma with decompressive craniectomy or craniotomy. Here, we present the protocol for a randomized controlled trial targeted at comparing the outcome and economic benefits of decompressive craniectomy versus craniotomy for the treatment of traumatic brain injury (TBI) patients with cerebral herniation undergoing evacuation of AEDH.Methods/design: Patients of both genders, aged from 18 to 65 years, presenting to the emergency room with a clinical and radiological diagnosis of AEDH with herniation, comply with other inclusion and exclusion criteria are enrolled. Clinical information, including diagnosis of AEDH, clinical radiological information and treatment procedures, follow-up data of 1, 3 and 6 months post injury are collected on 120 eligible patients, randomized into groups of decompressive craniectomy versus craniotomy in a 1:1 ratio among 51 centers. The primary outcome is the Glasgow Outcome Score-Extended (GOSE) at 6 months post-injury. Secondary outcomes include incidence of post-operative cerebral infarction, incidence of additional craniocerebral surgery, and other evaluation indicator within 6 months post-injury.Discussion: This study is expected to help neurosurgeons make a better decision to evacuate the epidural hematoma with or without a DC, especially for patients with brain herniation, and improve current situation of lack of general evidence.Trial registration: Clinicaltrials.gov: NCT 04261673 (Registration date: 04 February 2020)

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