Journal of neurological surgery. Part A, Central European neurosurgery最新文献

{"title":"Large Skull Metastasis in Follicular Thyroid Carcinoma: A Comprehensive Case Presentation and Systematic Review","authors":"Gianluca Scalia, Massimiliano Porzio, Roberta Costanzo, Eliana Giurato, Fabio Gibilisco, Domenico Gerardo Iacopino, Rosario Maugeri, Giovanni Federico Nicoletti, Giuseppe Emmanuele Umana, Raffaele Alessandrello","doi":"10.1055/s-0044-1785650","DOIUrl":"https://doi.org/10.1055/s-0044-1785650","url":null,"abstract":"<p>\u0000<b>Background</b> Skull metastases from follicular thyroid carcinoma (FTC) are infrequent but clinically significant, often presenting with localized pain, neurologic deficits, and cranial nerve dysfunction. Early detection and accurate diagnosis pose challenges due to their asymptomatic nature in some cases.</p> <p>\u0000<b>Methods</b> A systematic literature review, conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, identified and analyzed 15 relevant studies focusing on large skull metastases in FTC. Data extraction and synthesis included clinical presentation, diagnostic methods, treatment strategies, and patient outcomes.</p> <p>\u0000<b>Results</b> The systematic review encompassed 20 patients with secondary skull metastases from FTC, offering insights into the clinical diversity of this rare condition. Clinical presentations varied, with localized pain (70% of cases) and headaches being predominant symptoms. Imaging techniques, including computed tomography (CT) and magnetic resonance imaging (MRI), played a pivotal role in diagnosis. Surgical resection was considered in select cases, achieving complete or near-complete tumor removal in 30 to 50% of patients. Radiotherapy, including external beam radiation therapy (EBRT) and stereotactic radiosurgery (SRS), provided local control and symptom relief in 70 to 80% of cases. Systemic therapies, such as tyrosine kinase inhibitors (TKIs), showed promise in disease stabilization or regression (45% of patients). Prognosis remained poor, with a median overall survival of 6 to 12 months, reflecting an advanced and aggressive disease state.</p> <p>\u0000<b>Conclusion</b> Managing secondary skull metastases from FTC requires a comprehensive approach, including surgical intervention, radiotherapy, and potential systemic therapies. The rarity of these metastases underscores the need for further research to establish standardized treatment guidelines, explore molecular profiling, and investigate immunotherapy and combination therapies, offering hope for improved outcomes in this challenging clinical scenario.</p> ","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140599861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Safety of Bridging Antiplatelet Therapy with Cangrelor in Neuro-Oncology: A Preliminary Experience","authors":"Giacomo Bertolini, Laura Belli, Stefania Mazza, Pietro Tito Ugolotti, Iacopo Tadonio, Patrizia Ceccarelli, Sandra Rossi, Salvatore Ippolito","doi":"10.1055/s-0044-1785649","DOIUrl":"https://doi.org/10.1055/s-0044-1785649","url":null,"abstract":"<p>Antiplatelet therapy is mandatory for prevention of thrombotic events in patients with a recent history of acute coronary syndromes and/or percutaneous coronary interventions. However, if an urgent surgery is required during antiplatelet therapy, a compromise between the ischemic/thrombotic and hemorrhagic risk has to be reached. Different bridging schemes are reported in the literature, but there is no clear consensus on the optimal treatment strategy in terms of efficacy and safety. Although some indications about the perioperative management of antiplatelet therapy regarding specific surgical specializations are available, balancing the thrombotic and hemorrhagic risk on an individual basis, no evidence referring to neurosurgical or neuro-oncologic procedures is reported. Herein, we present our preliminary experience in the perioperative management of a patient who underwent a neurosurgical procedure for the resection of a primary malignant brain tumor using an intravenous P2Y₁₂ inhibitor (cangrelor) as bridging therapy after a recent acute myocardial infarction treated with primary percutaneous coronary intervention and stenting. The oral P2Y₁₂ inhibitor (clopidogrel) was withdrawn 5 days prior to the surgical procedure and continuous infusion of cangrelor was started 3 days before the surgery at a dose of 0.75 μg/kg/min. Cangrelor was discontinued 2 hours before surgery and resumed 72 hours after tumor resection for further 60 hours. Neither cangrelor-related bleeding nor cardiac ischemic events were observed in the perioperative period and the following 90 days, supporting data regarding the feasibility and safety of this bridging scheme. Further studies are needed to confirm our promising results.</p> ","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140599684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interaction between Neurogenic Pulmonary Edema and Thoracic 3 DRG Degeneration Following Spinal Subarachnoid Hemorrhage: First Experimental Study.","authors":"Deniz Sirinoglu, Buse Sarigul, Ayhan Kanat, Mehmet Dumlu Aydin, Rabia Demirtas","doi":"10.1055/a-2235-8556","DOIUrl":"10.1055/a-2235-8556","url":null,"abstract":"<p><strong>Background: </strong> Neurogenic pulmonary edema (NPE) following subarachnoid hemorrhage (SAH) is still one of the most catastrophic complications with high morbidity and mortality rates. Systemic sympathetic hyperactivity has been considered in the pathogenesis, but it has not been clarified. In this study, we investigate the relationship between the degeneration of the T3 dorsal root ganglion (DRG) and the development of NPE following spinal SAH.</p><p><strong>Methods: </strong> The study was conducted on 23 rabbits. Five rabbits were used as the control group, 5 as the sham group (<i>n</i> = 5), and 13 as the study group. The correlation between the degenerated neuronal densities of the T3 nerve axons and neurons in the DRG and NPE scores was analyzed statistically.</p><p><strong>Results: </strong> A correlation between the neuronal degeneration of the T3 nerve, its DRG, and high NPE scores was found in the study group and the sham group. Massive NPE was detected in the study group along with neural degeneration of T3 axons and ganglia.</p><p><strong>Conclusion: </strong> The present study indicates that NPE and pulmonary artery vasospasm can be prevented by reducing T3 DRG degeneration.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139058444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Single Standard Polyvinyl Chloride 3D Skull Model to Create the Polymethyl Methacrylate Cranioplasty Flap: A Novel and Low-Cost Technique","authors":"Hanuman Prasad Prajapati, Deepak Kumar Singh","doi":"10.1055/s-0044-1785648","DOIUrl":"https://doi.org/10.1055/s-0044-1785648","url":null,"abstract":"<p>\u0000<b>Background</b> Although, cranioplasty is a commonly performed neurosurgical procedure worldwide, the cost of available cranioplasty implants is a major issue in a low-income country like India. The aims of this study were to introduce a novel and low-cost technique using a single standard three-dimensional (3D) skull model to guide the polymethyl methacrylate (PMMA) cranioplasty flap production and to evaluate the functional and cosmetic outcomes.</p> <p>\u0000<b>Methods</b> We retrospectively evaluated 47 cases of PMMA cranioplasty in the period from February 2019 to June 2022. A single standard 3D skull model was used to make the PMMA cranioplasty flaps. The overall cost of this PMMA implant was compared with that of other available cranioplasty implants. The functional and cosmetic outcomes were evaluated postoperatively.</p> <p>\u0000<b>Results</b> The mean age of our patients was 37.17 ± 13.83 years and the age range was 17 to 63 years. The primary cause of surgery was trauma in the majority of cases (<i>n</i> = 31, 65.96%). The mean operative time was 78.55 ± 19.82 minutes. The cosmetic results were very satisfying in 46 of 47 (97.87%) patients and moderately satisfying in 1 (2.12%) patient. Overall, there were three (6.38%) complications.</p> <p>\u0000<b>Conclusion</b> Our technique provides excellent functional and cosmetic outcomes. The overall surgical cost of these PMMA implants was lower than that of the other available cranioplasty implants. This technique is currently the most cost-effective option for cranioplasty.</p> ","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140600012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventriculoperitoneal Shunt Surgery in Pediatrics: Does Preoperative Skin Antisepsis with Chlorhexidine/Alcohol Reduce Postoperative Shunt Infection Rate?","authors":"Ahmed Shawky Ammar, Hossam Elnoamany, Hany Elkholy","doi":"10.1055/a-2265-9325","DOIUrl":"10.1055/a-2265-9325","url":null,"abstract":"<p><strong>Background: </strong> In pediatrics, shunt infection is considered the most common complication of ventriculoperitoneal (VP) shunt insertion and the main cause of shunt failure. Careful surgical technique and hygienic skin preparations are highly important for prevention of shunt infections. Our objective was to assess the significance of using preoperative chlorhexidine/alcohol as a skin antiseptic in reducing the infection rate in pediatric VP shunts surgery.</p><p><strong>Methods: </strong> We conducted a retrospective, case control study of 80 pediatric patients with active hydrocephalus. The control group (a single step of preoperative skin antisepsis using povidone-iodine and isopropyl alcohol) comprised 40 patients who underwent a shunt surgery between January 2019 and June 2020 and the study group (two steps of preoperative skin antisepsis using 2% chlorhexidine gluconate in 70% isopropyl alcohol as a first step followed by povidone-iodine as a second step) comprised 40 patients who underwent a shunt surgery between July 2020 and January 2022.</p><p><strong>Results: </strong> Shunt infection was encountered in 11 (13.7%) patients. It was significantly higher in preterm babies (<i>p</i> = 0.010), patients with a previous shunt revision (<i>p</i> < 0.001), and those with a previous shunt infection (<i>p</i> < 0.001). The incidence of infection was 22.5% in the control group and 5% in study group, with a statistically significant difference (<i>p</i> = 0.023).</p><p><strong>Conclusions: </strong> Two steps of preoperative skin antisepsis, first using chlorhexidine/alcohol and then povidone-iodine scrub solution, may significantly reduce the infection rate in pediatric VP shunt surgeries.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139712417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Advantages of Spinal Anesthesia in Lumbar Disk Surgery","authors":"Mehmet Yigit Akgun, Helin İlkay Orak, Mehmet Huseyin Akgul, Ozkan Ates","doi":"10.1055/s-0043-1771267","DOIUrl":"https://doi.org/10.1055/s-0043-1771267","url":null,"abstract":"<p>\u0000<b>Background</b> Quality of life (QoL) may be affected due to various reasons such as low back or leg pains with accompanying neurologic problems. Lumbar disk surgery is one of the most common performed surgeries to relieve those symptoms. Various anesthetic techniques can be used safely to perform lumbar disk surgeries. Properties that make an anesthetic technique good are mainly the quick onset and returning of the effects. This large retrospective study with patients who have undergone lumbar disk surgery under spinal anesthesia aims to evaluate the perioperative and postoperative parameters of the spinal anesthesia and review the literature.</p> <p>\u0000<b>Methods</b> Cases operated under spinal anesthesia between January 2017 and December 2020 were investigated, and 617 patients who underwent simple lumbar disk surgery were included in the study. Demographic characteristics and American Society of Anesthesiologists (ASA) physical status of the patients were recorded. Visual analog scale (VAS) and QoLscores were obtained before and after the operation.</p> <p>\u0000<b>Results</b> There were 282 (45.7%) male and 335 (54.3%) female patients with a mean age of 39.48 ± 16.71 years (range: 18–58 years) at symptom onset. The mean operating time was 46.3 minutes (range: 22–68 minutes). Average blood loss was 85 mL (range: 55–125 mL). All the patients were mobilized 6 to 12 hours after surgery. In our patient group, there were both high- and normal-risk groups in terms of the ASA physical status. During the clinical follow-up, a statistically significant improvement was found for the VAS and QoL scores (<i>p</i> < 0.05).</p> <p>\u0000<b>Conclusions</b> In this large retrospective study, our results have confirmed that spinal anesthesia is at least comparable to general anesthesia and even superior to it in some aspects.</p> ","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140599682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of SINO robot combined with Angio Render technology-assisted stereo-electroencephalography electrode implantation for the treatment of drug-resistant epilepsy.","authors":"Yihai Dai, Rifeng Jiang, Jingyi Zhang, Zhe Qian, Zhen Chen, Songsheng Shi, Shiwei Song","doi":"10.1055/a-2299-7781","DOIUrl":"https://doi.org/10.1055/a-2299-7781","url":null,"abstract":"BACKGROUND AND OBJECTIVE\u0000Stereo-electroencephalography (SEEG) electrodes are implanted using a variety of stereotactic technologies to treat refractory epilepsy. The value of SINO-robot for SEEG electrode implantation is rarely reported. The aim of the current study was to assess the value of SINO-robot in conjunction with Angio Render technology, in SEEG electrode implantation. We also assess its efficacy by examining factors such as localization error, operation time, and complications.\u0000\u0000\u0000METHODS\u0000Between June 2018 and October 2020, we retrospectively reviewed 58 patients who underwent SEEG implantation to resect or ablate their epileptogenic zone (EZ) while minimizing the risk of hemorrhage. SINO-robot combined with Angio Render technology-assisted SEEG electrode implantation was used to visualize each patient' blood vessel in a 3D plane. The 3D view functionality was used to increase the safety and accuracy of the implantation, and reducing the risk of hemorrhage by avoiding said blood vessel.\u0000\u0000\u0000RESULTS\u0000In this study, 634 SEEG electrodes were implanted in 58 patients. The mean 10.92(range 5- 18) leads per patient. The mean entry point localization error (EPLE) was 0.94 ± 0.23 mm (range: 0.39- 1.63 mm), and the mean target point localization error (TPLE) was 1.49 ± 0.37 mm (range: 0.80-2.78 mm). The mean operating time per lead (MOTPL) was 6. 18 ± 1.80 min (range: 3.02- 14.61 min). And the mean depth of electrodes was 56.96± 3.62 mm (range:27.23-124.85 mm). At a follow-up of at least one year, totally 81.57% (47/58) of patients achieved an Engel class I of seizure freedom. There were 2 patients with asymptomatic brain hematomas following SEEG placement, and no late complications or mortality in this cohort.\u0000\u0000\u0000CONCLUSIONS\u0000SINO-robot in conjunction with Angio Render technology assist, in SEEG electrode implantation is safe and accurate in mitigating the risk of intracranial hemorrhage in patients suffering from drug-resistant epilepsy.","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140742662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing Safe Surgical Parameters for Placement of C2 Pedicle Screws: A Retrospective Study.","authors":"Bekir Tunç, Denizhan Divanlıoğlu, Göksal Günerhan, Egemen Işıtan, Emin Çağıl, Ali Dalgıç","doi":"10.1055/a-2235-5381","DOIUrl":"10.1055/a-2235-5381","url":null,"abstract":"<p><strong>Background: </strong> The study aimed to evaluate the safety and feasibility of transpedicular instrumentation for the C2 vertebra and to establish the precise anatomical parameters and boundaries within which this procedure can be safely and effectively performed.</p><p><strong>Methods: </strong> This retrospective study analyzed 66 patients who underwent C2 transpedicular screw fixation. Preoperative and postoperative axial, sagittal, and coronal computed tomography (CT) scans were examined. Anatomical measurements were taken to determine the horizontal and vertical distances from the C2 pedicle projection to the vertebral foramen using CT images. Based on the anatomical location of the vertebral artery within the C2 vertebral foramen, the patients were divided into four subgroups using the horizontal pedicle width (HPW) and vertical pedicle width (VPW) of the C2 spine.</p><p><strong>Results: </strong> The average age of the patients included in the study was 46.48 years. The patient population comprised 32 (48.5%) males and 34 (51.5%) females. Based on the anatomical measurements, the distribution of C2 vertebra types was as follows: type 1 accounted for 68.9%, type 2 for 3.8%, type 3 for 16.7%, and type 4 for 10.6%. Significantly narrower pedicle widths were observed in types 2 and 4 compared to other vertebra types. Type 2 had the largest medial angle (MA), while type 4 had the narrowest MA. In terms of the sagittal plane, type 4 exhibited the widest MA and type 3 had the narrowest MA, but these differences were not statistically significant. Among the cases, 12 (18.1%) involved the vertebral foramen, with 1 case (8.3%) showing screw-related vertebral artery injury (0.75% of all screws). No vertebral artery injuries were observed with the other transpedicular screws.</p><p><strong>Conclusion: </strong> Preoperative anatomical measurements for patients undergoing transpedicular instrumentation on the C2 vertebra should include planning CT images on three planes: axial, sagittal, and coronal.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Extension of Traumatic Subdural Hematoma into the Interhemispheric Fissure Is Associated with Coagulation Disorders: A Retrospective Study.","authors":"Lennart W Sannwald, Dag Moskopp, Mats L Moskopp","doi":"10.1055/s-0043-1777859","DOIUrl":"https://doi.org/10.1055/s-0043-1777859","url":null,"abstract":"<p><strong>Background: </strong> This study investigates the correlation of the radiologic sign of interhemispheric subdural hematoma (iSDH) in different injury patterns with clinical coagulation disorders. It is hypothesized that the presence of iSDHs is correlated with clinical coagulation disorders in patients with traumatic brain injuries and subdural hematoma (SDH).</p><p><strong>Methods: </strong> Between January 1, 2020 and June 30, 2022, 154 patients with SDH were identified. Coagulation disorders were assessed using chart review and patients were divided into four groups: SDH without iSDH without further injuries (SDH), SDH with iSDH without further injuries (SDH + iSDH), SDH without iSDH with further brain injuries (Combi), SDH with iSDH with further injuries (Combi + iSDH). These four groups were formed under the assumption that isolated SDHs result from a highly specific trauma mechanism (rupture of bridging veins) in predisposed elderly patients, while combined brain injuries with SDH result from a severe global traumatic brain injury combining different pathophysiologic mechanisms often in younger patients. The groups were analyzed for patient demographics, clinical presentation, and association with coagulation disorders. The significance level was set at <i>p</i> < 0.005.</p><p><strong>Results: </strong> The presence of an iSDH was associated with a higher likelihood of concomitant coagulation disorder or anticoagulants in cases of isolated subdural hemorrhage (56.8% of the population in SDH vs. 94.7% in SDH + iSDH, <i>p</i> < 0.005). This effect was not significant in the cases with combined traumatic brain injuries (33.3% in Combi vs. 53.6% in Combi + iSDH, <i>p</i> > 0.005).</p><p><strong>Conclusion: </strong> Our data indicate a high positive predictive value (PPV = 94.7%) for coagulation disorders in traumatic SDH patients with iSDH without any further focal and diffuse brain injuries. We consider this a relevant finding since it hints at the presence of coagulation disorders and might be used in early hemostaseologic assessment and emergency management.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140326702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subdural Hematoma due to Dural Metastasis: A Systematic Review on Frequency, Clinical Characteristics, and Neurosurgical Management.","authors":"Bhavya Pahwa, Anish Tayal, Atulya Chandra, Joe M Das","doi":"10.1055/s-0044-1782141","DOIUrl":"https://doi.org/10.1055/s-0044-1782141","url":null,"abstract":"<p><strong>Background: </strong> Subdural hematoma (SDH) occasionally accompanies dural metastasis and is associated with high recurrence rate, significantly impacting patient morbidity and mortality. This systematic review aims to evaluate the characteristics, management options, and outcomes of patients with SDH associated with dural metastasis.</p><p><strong>Methods: </strong> A comprehensive search of the PubMed and Cochrane databases was conducted for English-language studies published from inception to March 20, 2023, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors reviewed cases of histopathologically confirmed SDH with non-central nervous system (non-CNS) tumor metastasis, focusing on therapeutic management of SDH. Statistical analysis was performed using SPSS software, with a significance level set at 0.05.</p><p><strong>Results: </strong> This review included 32 studies comprising 37 patients with 43 SDH cases associated with dural metastasis. Chronic SDH was the most frequently observed presentation (<i>n</i> = 28, 65.12%). The systemic malignancies most commonly associated with SDH due to dural metastasis were prostate carcinoma (<i>n</i> = 9, 24.32%) and gastric carcinoma (<i>n</i> = 5, 13.51%). A statistically significant association was found between metastatic melanoma and subacute SDH (<i>p</i> = 0.010). The majority of patients were treated with burr holes (<i>n</i> = 15, 40.54%) or craniotomies (<i>n</i> = 14, 37.84%), with no statistically significant difference in mortality rates between the two techniques (<i>p</i> = 0.390). Adjuvant therapy was administered to a limited number of patients (<i>n</i> = 5, 13.51%), including chemotherapy (<i>n</i> = 2, 5.41%), whole brain radiotherapy (<i>n</i> = 1, 2.70%), a combination of chemotherapy and whole brain radiotherapy (<i>n</i> = 1, 2.70%), and transcatheter arterial chemoembolization (<i>n</i> = 1, 2.70%). The overall recurrence rate was 45.95% (<i>n</i> = 17), with burr holes being the most common management approach (<i>n</i> = 4, 10.81%). Within a median of 8 days, 67.57% (<i>n</i> = 25) of patients succumbed, primarily due to rebleeding (<i>n</i> = 3, 8.11%), disseminated intravascular coagulation (<i>n</i> = 3, 8.11%), and pneumonia (<i>n</i> = 3, 8.11%).</p><p><strong>Conclusion: </strong> This review highlights the need for improving existing neurosurgical options and exploring novel treatment methods. It also emphasizes the importance of dural biopsy in patients with suspected metastasis to rule out a neoplastic etiology.</p>","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140028254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}