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PubMed1975

Superimposed chronic subdural hygromas. Report of two cases.

Two cases are reported of separate but superimposed chronic subdural collections occurring over one cerebral hemisphere convexity. It is suggested that this phenomenon may account for some apparent recurrences of chronic subdural collections after simple burr-hole evacuation.

Brain Neoplasms↗
PubMed1977

Computerized tomography and surgical treatment in intracranial suppuration. Report of 30 consecutive unselected cases of brain abscess and subdural empyema.

The authors report their experience with 30 cases of intracranial suppuration: 23 with brain abscess and seven with subdural empyema. All of the cases were diagnosed by means of computerized tomography and enhancement with intravenous contrast material. Most of the patients were treated by single or repeated aspiration through burr holes.

Brain Abscess↗
PubMed1982

Interposition saphenous vein grafts for advanced occlusive disease and large aneurysms in the posterior circulation.

The authors report their initial experience with the use of interposition saphenous vein grafts between the external carotid artery and the proximal posterior cerebral artery. The indications, results, and technical aspects of the operation are reviewed. All patients accepted for surgery were at high risk for a posterior circulation infarct, and all patients with ischemic symptomatology had continued to progress while on anticoagulant drugs or anti-platelet agents. Thus, all patients were at high risk, and 11 of the 14 patients operated on were confined to bed before surgery. Intraoperative graft flows varied from 35 to 170 ml/min, and postoperative graft flows ranged from 75 to 311 ml/min in the patent grafts. There were three early graft occlusions and two late graft occlusions; these all occurred in patients with relatively low flows at the time of surgery (40 ml/min or lower). Subdural hygroma was the next most frequent complication to graft occlusion. It was thought to be caused by the pulsating graft anastomosed to a major vessel through a small opening in the basal arachnoid, which provided a new path for cerebrospinal fluid flow in patients with a degree of preexisting atrophy. One patient with a large aneurysm in the posterior circulation underwent proximal intracranial clipping of the vertebral artery and bypass grafting simultaneously. There were seven excellent results and two good results in nine patients in whom the graft remained patent. In the five patients with graft occlusion, there were two minor strokes, two major strokes, and one death.

Adult↗
PubMed1982

Intracranial subdural sarcoid granuloma. Case report.

A patient is reported in whom a subdural sarcoid granuloma caused symptoms of an intracranial mass lesion, and disappeared following steroid therapy. Twenty-three previous cases with large intracranial sarcoid granulomas have been documented, a review of these 24 cases leads the authors to conclude that: 1) neither symptoms nor nonhistological diagnostic studies, including computerized tomography, differentiate sarcoid from cerebral neoplasms or other central nervous granulomas; and 2) because sarcoid mass lesions frequently respond well to corticosteroid therapy, surgery should probably be reserved for cases in which there is diagnostic uncertainty, a need for emergency decompression, or lack of response to steroids.

Adult↗
PubMed1983

A clinical comparison of subdural screw pressure measurements with ventricular pressure.

Simultaneous recordings of intracranial pressure (ICP) from a single-lumen subdural screw and a ventricular catheter were compared in 10 patients with severe head injury. Forty-one percent of the readings corresponded within the same 10 mm Hg ranges, while 13% of the screw pressure measurements were higher and 46% were lower than the associated ventricular catheter measurements. In 10 other patients, also with severe head injury, pressure measurements obtained with the Leeds-type screw were similarly compared with ventricular fluid pressure. Fifty-eight percent of the dual pressure readings corresponded, while 15% of the screw measurements were higher and 27% were lower than the ventricular fluid pressure, within 10-mm Hg ranges. It is concluded that subdural screws may give unreliable results, particularly by underestimating the occurrence of high ICP.

Cerebral Ventricles↗
PubMed1984

Subdural strip electrodes for localizing epileptogenic foci.

Surgical removal of epileptogenic brain is indicated for treatment of many medically refractory focal seizure disorders. One of the important factors in providing good results from surgery is the accuracy of identifying the epileptogenic focus. However, accurate localization may be difficult when only standard scalp recordings are used. Many epilepsy centers have used intracranial recording techniques to better define regions of cortical epileptogenicity . Although subdural strip electrodes were first utilized many years ago, the more popular method of intracranial recording has been by intracortical depth electrodes. The authors present their method of placing subdural strip electrodes for extensive recordings from the cortex. To date, this method has been used to provide continuous monitoring of the electrocorticogram in 28 patients for periods up to 3 weeks, with only two minor complications. This procedure is relatively safe and a valuable alternative to placing intracortical depth electrodes.

Cerebral Cortex↗
PubMed1985

Unilateral subdural-peritoneal shunting for bilateral chronic subdural hematomas in infancy. Report of three cases.

The authors present the cases of three infants with bilateral chronic subdural hematomas (SDH's) (effusions). Communication between the hematoma cavities was confirmed by an injection of air or metrizamide into one of the cavities. In all three cases, both SDH's (effusions) were successfully treated by placement of a unilateral subdural-peritoneal shunt without any untoward consequences. It is stressed that the cavities of bilateral chronic SDH's (effusions) may communicate, and that in such cases unilateral subdural-peritoneal shunting is sufficient to eradicate the SDH's on both sides. In addition, subdural fluid, even with a high protein concentration, may be successfully eliminated by an internal shunt using a shunt tube with a large internal caliber and a low-pressure valve.

Female↗
PubMed1985

Clinical evaluation of two methods of subdural pressure monitoring.

Recordings from two different types of subdural pressure monitor with simultaneous intraventricular pressure (IVP) tracings are compared in 20 head-injured patients. In the first 10 patients a fluid-filled catheter was placed subdurally and connected to an external transducer, and in the second 10 the Gaeltec model ICT/b solid state miniature transducer was used. The latter system has the advantage that both zero and calibration checks can be carried out after insertion. Only 44% of the fluid-filled catheter readings corresponded with IVP in series of 10-mm Hg ranges, while 53% of readings were lower; this tendency was more marked at higher pressures. With the Gaeltec transducer, 72% of subdural pressure readings corresponded with IVP, while only 9% were lower and 19% were higher than IVP. The differences may have been due to technical causes or to true pressure differentials. The subdural catheter appears too unreliable for routine clinical use, but the Gaeltec transducer may be a satisfactory alternative to ventricular pressure monitoring.

Brain Injuries↗