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PubMed1986

Treatment of chronic subdural hematoma by twist-drill craniotomy with continuous catheter drainage.

The case records of 114 patients were reviewed to ascertain the efficacy of bedside twist-drill craniotomy and continuous closed-system catheter drainage for the treatment of chronic subdural hematomas. Ninety-eight (86%) patients achieved an excellent outcome, and seven (6%) had no significant improvement. The total mortality from all cases was 8% in this group. Successful catheter drainage of the chronic subdural hematoma was accomplished by either one or two catheter placements in 102 (90%) patients. Twelve patients required additional operative procedures. The mean duration of hospitalization for the study group was 16 days. No infections occurred in these patients. Remission of the clinical syndrome did not require the radiographic resolution of the chronic subdural hematoma.

Adult↗
PubMed1987

Choroid plexus tumors: problems in diagnosis and management.

Choroid plexus tumors are uncommon neoplasms of the central nervous system. A series of 11 cases from the Vancouver General and British Columbia Children's Hospitals, treated during the last 12 years, are reviewed. Some of the management problems commonly encountered with these tumors are discussed. Many of these tumors are associated with severe hydrocephalus at the time of diagnosis, and the perioperative management of this hydrocephalus remains a matter of some debate. The timing of and the necessity for shunting are major considerations. Large subdural fluid collections are often discovered in the postoperative period, and these occasionally cause symptoms of increased intracranial pressure. Reasons for this problem are suggested and possible steps for its prevention are proposed. The similarity between papillary ependymomas and choroid plexus papillomas has sometimes caused difficulty in pathological diagnosis. Choroid plexus carcinomas, of which there were two in this series, also present a diagnostic challenge. Differential diagnosis affects the further treatment and prognosis for the patient.

Adult↗
PubMed1991

The morbidity of long-term seizure monitoring using subdural strip electrodes.

The authors report a prospective study of morbidity associated with long-term seizure monitoring using subdural strip electrodes. Three hundred fifty patients were divided into two groups: 175 patients received antibiotics intravenously during the entire period that the electrodes were implanted, and 175 patients received one dose of antibiotics on the morning of surgery. In the group given continuous antibiotic coverage there were two cases of meningitis, both treated without sequelae. In the group receiving one dose of antibiotics, one patient had a brain abscess and three had superficial wound infections. There were no other instances of major morbidity or mortality in either group of patients. The total morbidity rate for both serious and minor complications was 0.85%.

Adult↗
PubMed1993

Primary (granulomatous) angiitis of the central nervous system with multiple aneurysms of spinal arteries. Case report.

A 55-year-old woman with primary (granulomatous) angiitis of the central nervous system in association with non-Hodgkin's lymphoma (mucosa-associated lymphoid tissue type) presented with an acute spinal subdural hemorrhage secondary to rupture of one of several fusiform inflammatory aneurysms of the spinal cord radicular arteries. The literature on hemorrhagic complications, aneurysms, and spinal cord involvement in granulomatous angiitis is reviewed. Recognition of granulomatous angiitis is important, as the condition may be responsive to immunosuppressive therapy.

Aneurysm↗
PubMed2000

Surgical treatment of intractable epilepsy accompanying cortical dysplasia.

OBJECT: Surgical treatment of cortical dysplasia (CD) together with intractable seizures is challenging because both visualization and localization of the lesion are difficult, correlation with seizure foci requires comprehensive study, and the surgical outcomes reported thus far are unsatisfactory. The authors report their experience in the surgical treatment of CD classified according to a surgical point of view. METHODS: The definition of CD used in this study was a dysplastic lesion visible on magnetic resonance (MR) images or a lesion that, although not visible on MR images, was diagnosed as moderate-to-severe dysplasia by using pathological analysis. During the last 4.5 years, the authors treated 36 patients with intractable epilepsy accompanied by CD. They divided the 36 cases of CD into four characteristic groups: Group A, diffuse bilateral hemispheric dysplasia; Group B, diffuse lobar dysplasia; Group C, focal dysplasia; and Group D, a moderate to severe degree of CD with a normal appearance on MR images. All but one patient in Group C were monitored in the epilepsy monitoring unit by using subdural electrodes for seizure localization and functional mapping. The incidence of CD among a cohort of 291 patients who had undergone epilepsy surgery at the authors' center during the study period was 12.4%. The mean age of the 36 patients was 21.3 years and the mean age at seizure onset was 8.5 years. The mean follow-up period was 26 months. Twenty-six patients (72.2%) belonged to Engel Class I or II (20 and six, respectively). There were five cases in Group A, nine in Group B, nine in Group C, and 13 in Group D. Patients in Groups A and B were significantly younger at seizure onset and had significantly poorer surgical outcomes compared with patients in Groups C and D (p < 0.05). If outcome is compared on the basis of the extent of removal of CD, patients in whom CD was completely removed had significantly better outcomes than those in whom CD was only partially removed (p < 0.001). CONCLUSIONS: The authors conclude that intractable epilepsy accompanied by CD can be treated surgically using comprehensive preoperative approaches. Deliberate resective procedures aimed at complete removal of dysplastic tissue ensure excellent seizure control without permanent neurological deficit.

Adolescent↗
PubMed2001

Subduroperitoneal drainage for subdural hematomas in infants: results in 244 cases.

OBJECT: Subduroperitoneal drainage (SDPD) is commonly used in the treatment of infantile subdural hematomas (SDHs). Few studies have focused on this technique and most series have included SDHs of various origins in children of different ages. The surgical procedure is not standardized and results achieved using this technique have not been well documented. The authors reviewed their cases of traumatic SDH treated with SDPD in infants (< 2 years of age). Their standard technique includes bilateral SDPD whenever the SDH is bilateral, placement of a free shunt, and systematic removal of the drainage unit after a few months. METHODS: The authors performed SDPD in 244 infants with traumatic SDH. The patients' SDHs were controlled by SDPD in 241 cases, and 78.9% of the patients recovered to live a normal life. Complications of SDPD occurred in 38 patients (15.6%): obstruction in 22 cases (9%), infection in eight cases (3.28%), and internal hydrocephalus in eight cases (3.28%). Early complications could be ascribed to surgical technique, delayed complications were associated with the severity of the initial clinical presentation, and late complications were time dependent and unrelated to initial clinical severity. Poor clinical outcome was correlated to the severity of the initial presentation, but not to complications of surgery. CONCLUSIONS: Because of its efficacy and low complication rate, SDPD is the procedure of choice when subdural taps fail to control SDH. The authors prefer bilateral drainage because of the low rate of complications. Drains should be systematically removed after a few months to prevent long-term complications.

Arteriovenous Shunt, Surgical↗
PubMed2003

Use of an anteromedial subdural strip electrode in the evaluation of medial temporal lobe epilepsy. Technical note.

The temporal lobe is the most common site of partial epilepsy that is amenable to surgical therapy, and therefore ictal localization in this region is important. The authors describe the application of an anteromedial subdural strip electrode for the evaluation of epilepsy originating from the medial temporal lobe. This strip is advanced around the temporal pole and underneath the lesser wing of the sphenoid bone as it follows the medial temporal lobe contour. The advantages of this method of placement are the consistent path and reliable final position of the strip along the medial basal temporal lobe surface. This method allows adequate coverage of the parahippocampal gyrus along its long axis extending posterior to the level of the collicular plate. This technique has been used with no complications during intracranial monitoring of more than 100 patients with presumed temporal lobe epilepsy.

Anterior Thalamic Nuclei↗
PubMed2006

Diagnostic method for differentiating external hydrocephalus from simple subdural hygroma.

OBJECT: The various terms used to describe subdural fluid collection--"external hydrocephalus", "subdural hygroma", "subdural effusion", "benign subdural collection", and "extraventricular obstructive hydrocephalus"-reflect the confusion surrounding the diagnoses of these diseases. Differentiating external hydrocephalus from simple subdural hygroma may be difficult, but the former appears to be a distinct clinical entity separate from the latter. In this report, the authors present a diagnostic method for differentiating external hydrocephalus from simple subdural hygroma, based on their clinical experience in treating subdural fluid collection after mild head trauma. METHODS: Twenty patients with subdural fluid collection after mild head trauma were included in this study. Ventricle size was measured using a modified frontal horn index (mFHI); that is, the largest width of the frontal horns divided by the bicortical distance in the same plane, instead of the inner table distance. Bur hole trephination was performed on the appearance of a subdural fluid collection thicker than 15 mm on computed tomography (CT), persistent (longer than 4 weeks) or increasing in size, and accompanied by neurological symptoms (confusion or memory impairment). During the procedure, subdural pressure was measured using a manometer before opening the dura mater. Subdural pressure varied among the patients, ranging from 3 to 27.5 cm H2O. Four patients with a subdural pressure greater than 15 cm H2O had hydrocephalus after surgery (p < 0.05). Hydrocephalus developed in a pediatric patient (2 years old) with a subdural pressure of 12 cm H2O. All of the patients in whom hydrocephalus developed after bur hole trephination had had enlarged ventricles (mFHI > 33%) on preoperative CT scans. CONCLUSIONS: Monitoring subdural pressure may be a valuable tool for differentiating subdural hygroma from external hydrocephalus in patients with mild head trauma. Additionally, the mFHI reflects the nature of the subdural collection more accurately than the standard frontal horn index.

Adolescent↗
PubMed2003

Epileptogenic foci on subdural recording in intractable epilepsy patients with temporal dysembryoplastic neuroepithelial tumor.

To investigate the epileptogenic foci in dysembryoplastic neuroepithelial tumor (DNT) in the temporal lobe, we studied extraoperative electrocorticography (ECoG) with subdural electrode arrays from nine patients with intractable epilepsy due to temporal DNT. Ictal onset zones and irritative zones were decided by the ECoG. The locations of these zones were compared to the location of the tumor. The number of ictal onset zone and irritative zone was 2.1+/-0.93 and 2.9+/-1.45 in a patient with a DNT. They were detected more frequently in the adjacent tissues of the tumor (88.9%) rather than within the tumor or in mesial temporal area (66.7%). Mesial temporal involvement was found in 6 patients (66.7%) as an ictal onset zone, and in 5 (55.6%) as an irritative zone. The 7 patients (77.8%) had ictal onset zone in areas different from active irritative zone. The surgical outcome was better, when ictal onset zone was completely resected rather than partially removed. Temporal DNT can make multiple ictal onset zones and irritative zones in different regions including the mesial temporal area. Deliberate resection of epileptogenic foci, including all ictal onset zones and irritative zones, ensures excellent seizure control.

Adolescent↗
PubMedDate not supplied

CT and pathologic findings of a case of subdural osteoma.

A 43-year-old female presented with persistent headache and dizziness which had first occurred two years earlier. The physical and neurological findings at admission were unremarkable, though plain radiography revealed the presence of a dense calcified mass in the left frontal area, and CT showed that a homogeneous high-density nodule was attached to the inner surface of the left frontal skull. The hard bony mass found and excised during surgery was shown at histopathologic examination to be a subdural osteoma. We describe the clinicopathologic findings of this entity and discuss the radiological features which suggest its subdural location.

Adult↗
PubMed2002

Meningeal worm is a long-lived parasitic nematode in white-tailed deer.

A natural infection of the meningeal worm, Parelaphostrongylus tenuis, persisted for at least 3.7 yr in a white-tailed deer (Odocoileus virginianus). The deer was 5-7 yr old and was shedding dorsal-spined nematode larvae at the time of quarantine. Larvae were extracted from all fecal samples collected up to 730 days post-quarantine (dpq) and thereafter only at 862 dpq and at necropsy (1,350 dpq). Live adults of P. tenuis, one male and one female, were recovered from the cranium at necropsy. Parelaphostrongylus tenuis infections are long lived and latent periods may be extended. Our findings reaffirm the need for reliable antemortem diagnosis to identify non-patent P. tenuis infections to prevent inadvertent introduction of infected animals to non-endemic areas.

Animals↗
PubMed2002

Low-dose meningeal worm (Parelaphostrongylus tenuis) infections in moose (Alces alces).

Parelaphostrongylosis has a rapid onset and is lethal in neonatal moose (Alces alces) when large numbers of third-stage Parelaphostrongylus tenuis larvae (L3) are given experimentally. Little is known, however, about the severity and prognosis of infections acquired naturally by accidentally ingesting terrestrial gastropods which are rarely infected and have few larvae. To investigate the relationship between infecting dose, age of moose, and severity of disease, five calves were given low doses of three to 10 L3 when five (n = 2) or 9.5 mo old (n = 3). Each of two animals initially given low doses were later challenged with a dose of 15 L3. As positive controls, two calves were given doses of 15 and 30 L3, considered to be high. All five calves given low doses showed abnormal locomotory signs at 20-28 days postinoculation (DPI) that progressively became more pronounced with hind quarter weakness and front lameness. However, after 77-130 DPI, signs diminished markedly in two of these animals and disappeared in another two. Challenge infections of 15 L3 given 199 days after initial infections had no noticeable effects although an immature worm, probably resulting from the challenge, was found in the spinal cord of one animal killed 51 days later. Two positive control animals given the high doses of 15 and 30 L3 showed moderate to severe, non-resolving, locomotory signs and had to be euthanized. Results demonstrate that single, low doses of three to 10 P. tenuis L3 cause moderate disease in moose calves but over time, some worms die and animals can recover. A degree of protection may develop against future infection.

Animals↗
PubMedDate not supplied

[The morphological characteristics of chronic subdural hematomas].

Preparations of chronic subdural hematomas (CSH) obtained during surgery from 29 patients aged 19-50 years are studied. Histological sections were stained with hematoxylin-eosin after van Gieson. Morphological criteria of CSH variants are defined, permitting forensic medical experts to make well-based conclusions on the nature (traumatic or not) of CSH (two types of capsules) and the time when it occurred.

Adult↗