Asian journal of neurosurgery最新文献

{"title":"Predicting Factors Associated with In-hospital Mortality in Traumatic Brain Injury.","authors":"Pejman Hamouzadeh, Vali Baigi, Vafa Rahimi-Movaghar, Mohammadreza Zafarghandi, Payman Salamati","doi":"10.1055/s-0044-1793930","DOIUrl":"10.1055/s-0044-1793930","url":null,"abstract":"<p><strong>Introduction: </strong>The accurate identification of predictors of mortality is of utmost importance in risk stratification, as it empowers health care teams to efficiently allocate resources and interventions to patients who are at a higher risk. Our objective was to investigate the factors linked to in-hospital mortality in patients who have suffered a traumatic brain injury (TBI).</p><p><strong>Materials and methods: </strong>This study employed a retrospective design, utilizing data from the National Trauma Registry of Iran spanning September 17, 2016, to July 31, 2022. The study included TBI patients admitted to participating hospitals with a hospital stay exceeding 24 hours, those who died during hospitalization, or those transferred from other facilities. TBI cases were identified using specific International Classification of Diseases, Tenth Revision codes. The study incorporated various variables, including baseline characteristics such as age (categorized into pediatric, adult, and geriatric groups), gender, trauma mechanism, and mode of transportation. Clinical characteristics considered included the Glasgow coma scale (GCS), injury severity score (ISS), types of injuries sustained, interventions performed, and vital signs. The primary outcome was mortality following hospital admission.</p><p><strong>Results: </strong>The study included 874 patients, and the observed mortality rate was 12.2%. Road traffic crashes were identified as the leading cause of TBI, accounting for 72.5% of the cases. Utilizing multiple logistic regression analysis, the study confirmed that older age, severe GCS score, tracheostomy, and abnormal oxygen saturation were significant predictors of mortality.</p><p><strong>Conclusion: </strong>The findings of this study demonstrate that older age, lower GCS scores (severe TBI), tracheostomy, and abnormal oxygen saturation are significant predictors of mortality in patients with TBI. These results emphasize the significance of incorporating age, neurological status, and respiratory function into the assessment of prognosis and mortality risk in TBI patients. By considering these factors, health care professionals can better evaluate the potential outcomes and allocate appropriate care for TBI patients.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 2","pages":"229-235"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Extradural Angiolipoma: A Report of Two Cases and Review of Literature.","authors":"Sathish Kumar Thellakanthiah Ekambaram, Arul Muthukumaraswamy, Vigneshwar Kumbakonam Sivaraman, Gokulesh Devannagoundanur Gurumurthy, Nandini Vijayakumar","doi":"10.1055/s-0045-1802625","DOIUrl":"10.1055/s-0045-1802625","url":null,"abstract":"<p><p>Spinal extradural angiolipomas (SEALs) are rare, benign neoplasms composed of mature adipocytes and vascular elements. They are often noninfiltrating and located in the posterior aspect of the spinal canal at the level of thoracic/dorsal vertebrae. Back pain, progressive paraparesis, and sensory disturbance in lower limbs are the typical symptoms. Here, we discuss two cases of SEALs presenting with subacute paraparesis. The magnetic resonance imaging of one patient was reported to be suggestive of spinal metastasis/plasmacytoma/sarcoma, while the other was reported as a spinal extradural hematoma. After laminectomy, both lesions were recognized as encapsulated extradural tumors and en-bloc resection was done. Postoperatively, the neurological deficits improved and there was no recurrence on 2-year follow-up. Histopathology characterized both of them to be extradural angiolipomas. Current experience and literature support curative surgical resection as the gold standard. The prognosis is excellent in most cases, even if total resection is not feasible. It is due to the slow-growing nature of the tumor and absence of malignant transformation.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 2","pages":"387-390"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Clinoid Process Metastasis with Sudden Loss of Vision: Role of Emergency Optic Nerve Decompression.","authors":"Marta Rico Pereira, Fernando Muñoz Hernández","doi":"10.1055/s-0045-1806729","DOIUrl":"10.1055/s-0045-1806729","url":null,"abstract":"<p><p>Anterior clinoid process metastases are rare. We present an unusual case of anterior clinoid process metastasis with sudden deterioration of visual function requiring emergency optic nerve decompression, resulting in recovery of visual function. The patient was a 41-year-old man with a diagnosis of leiomyosarcoma of the radius, operated on in 2014, with bone and lung metastases, who had been treated with chemotherapy and appeared to have stable disease at his last follow-up. Six years later, he developed a 1-month history of progressive unilateral loss of visual acuity and visual field defect (initially quadrantanopia that progressed to nasal hemianopia). Brain imaging showed a contrast-enhancing lesion affecting the left anterior clinoid process with extension to the cavernous sinus and sphenoid sinus, causing compression of the left optic nerve. Although the lesion could have suggested a meningioma given the location, in the context of the patient's oncological history, the diagnosis of metastasis was considered more likely. The patient was admitted to the hospital and, during the hospital stay, developed sudden left retro-orbital pain progressing to left amaurosis over approximately 8 hours. Urgent surgery was performed: a pterional craniotomy with partial tumor removal and optic nerve decompression with extradural anterior clinoidectomy. After surgery, the patient had an immediate but partial improvement in visual acuity and in the visual field defect. Metastasis to the anterior clinoid process is very uncommon, with only one case previously reported in the literature. In cases of visual impairment, symptoms may deteriorate rapidly to complete loss of vision, so urgent decompressive surgery of the optic pathway may be indicated to recover visual function, although recovery may be partial.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 2","pages":"423-426"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare Presentation of Anterior Cervical Arachnoid Cyst in an Adolescent with Rapidly Progressive Quadriparesis: A Case Report.","authors":"Jeevesh Mallik, Manoj Kumar, Niraj Kumar Choudhary","doi":"10.1055/s-0045-1806801","DOIUrl":"10.1055/s-0045-1806801","url":null,"abstract":"<p><p>An arachnoid cyst is mostly congenital CSF-filled space occurring in the brain and spine. In the spine, they are usually found in the posterior aspect. Anterior cervical arachnoid cyst is very uncommon. A 14-year-old adolescent boy presented with rapidly progressive quadriparesis starting with the left lower limb, which is associated with radiating pain and numbness in both upper extremities. There was no sensory deficit, and the bladder and the bowel were normal. The radiological evaluation with contrast-enhanced MRI was suggestive of an anterior cervical intradural arachnoid cyst, for which the patient underwent surgery with wide fenestration and partial removal of the cyst wall, and the cyst wall was sent for histopathological examination. The patient improved postoperatively without any residual deficit. Anterior cervical arachnid cyst is a very rare lesion and should be considered in children and young adults who presented with neck pain or radiculopathy, especially if they are followed by motor weakness.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 2","pages":"431-435"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive L5-S1 Anterior TLIF Cage Placement in Lateral ALIF Exposure as a Bailout Option for Low Iliocaval Junctions: Report of Four Cases.","authors":"Timothy Y Kim, Martin H Pham","doi":"10.1055/s-0045-1806728","DOIUrl":"10.1055/s-0045-1806728","url":null,"abstract":"<p><p>The aim of this study was to demonstrate that anteriorly placed transforaminal lumbar interbody fusion (TLIF) footprint bullet cage is a safe and effective bailout option if difficult left common iliac vein (LCIV) anatomy is unexpectedly encountered during the L5-S1 lateral anterior lumbar interbody fusion (L-ALIF). This retrospective case series includes four patients who received anteriorly placed TLIF cages at L5-S1 during L-ALIF surgery. Demographics, complications, and clinical/radiographic results were collected. The analysis included four female patients with a mean age of 59.0 years and mean body mass index (BMI) of 23.9. Three patients had degenerative conditions and one patient had a deformity. All the patients had an LCIV obstructing the center of the L5-S1 disk space, and titanium TLIF bullet cages were placed and secured with washers and screws. The L5-S1 segmental lordosis increased by 8.3 ± 6.1 degrees with a final mean lordosis of 23.5 ± 8.4 degrees; the L5-S1 intradiskal angle increased by 12.0 ± 7.0 degrees with a final mean disk angle of 18.8 ± 7.0 degrees; the posterior disk height increased by 4.4 ± 2.7 mm with a final mean disk height of 8.0 ± 2.1 mm. The mean numerical rating scale (NRS) for back pain improved by 5.3 ± 2.5 and the mean NRS leg pain improved by 7.7 ± 2.5 over a mean follow-up of 14 months (range: 6-20). There have been no perioperative complications or implant failure to date. If challenging vascular anatomy is encountered during L-ALIF exposure that prevents ALIF footprint cage placement, proceeding with smaller TLIF bullet cage placement anteriorly rather than abandoning the surgical approach is a safe and effective option.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 2","pages":"417-422"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracranial-Intracranial Bypass with Reconstruction Clip Surgery Following Failed Flow Diverter Therapy for a Giant Internal Carotid Aneurysm: A Case Report.","authors":"Hung Manh Ngo, Minh Quang Ngo","doi":"10.1055/s-0045-1805019","DOIUrl":"10.1055/s-0045-1805019","url":null,"abstract":"<p><p>Flow diverter (FD) is often the first-line treatment for giant internal carotid artery aneurysms, with a high rate of aneurysm occlusion. However, up to 10% of giant cerebral aneurysms increase in size after FD treatment. Surgery is usually considered if the giant internal carotid artery aneurysm continues to enlarge and cause compression. We report a case of a giant internal carotid artery aneurysm that continued to increase in size after FD treatment and was subsequently treated surgically. We also review the literature on the management of giant cerebral aneurysms that increased in size after FD. A 41-year-old female patient was diagnosed with a right giant internal carotid artery aneurysm and was initially treated with FD. After FD, the patient's vision in the right eye did not improve. Despite medical treatment, her vision continued to deteriorate. The patient presented at our hospital with reduced vision in both eyes. Magnetic resonance imaging and digital subtraction angiography with balloon test occlusion confirmed the presence of a giant thrombosed aneurysm in the right internal carotid artery, compressing the right optic nerve and optic chiasm. The patient underwent external carotid artery-middle cerebral artery bypass surgery using a radial artery graft, aneurysm sac dissection with thrombus removal, and reconstructive clipping of the aneurysm neck. After surgery, the patient's vision in both eyes improved immediately and did not develop any new neurological symptoms. Extracranial-intracranial arterial reconstructive surgery is a viable option for treating giant internal carotid artery aneurysms that have undergone FD treatment but continue to present with progressive mass effects.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 2","pages":"391-396"},"PeriodicalIF":0.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of Detachable Balloon Embolization in Traumatic Carotid Cavernous Fistula.","authors":"Sujin Rujimethapass","doi":"10.1055/s-0045-1805017","DOIUrl":"10.1055/s-0045-1805017","url":null,"abstract":"<p><p><b>Objectives</b>  This article evaluates the outcomes and efficacy of detachable balloon embolization by single balloon delivery catheter, while identifying factors associated with successful embolization in traumatic carotid cavernous fistula (TCCF) patients. <b>Materials and Methods</b>  We retrospectively collected data of TCCF patients who underwent detachable balloon embolization during March 2020 to April 2024. All cases utilized a single balloon delivery catheter for detachable balloon deployment (GOLDBAL, BALT Extrusion, France). We analyzed demographic, clinical, imaging, and angiographic data, including outcomes, complications, and factors associated with successful embolization. <b>Results</b>  Thirty patients were treated with detachable balloon embolization. The mean age of the patients was 41.1 years (range 17-65 years). The median duration of symptom was 2.0 months (range 0.25-60 months). The most common mechanism of injury is motorcycle accident (83.3%). Nearly all patients had eye redness and proptosis. Angiographic data indicated 29 patients (96.7%) had drainage to the inferior petrosal sinus, 28 (93.3%) had drainage to the superior ophthalmic vein, and 8 (26.7%) had drainage to the superior petrosal sinus. Five cases (16.7%) were classified as small-sized fistula, 19 (63.3%) as medium-sized, and 6 (20%) as large-sized. Regarding the location of the fistula, 8 cases (26.7%) were found in the horizontal segment, while 22 cases (73.3%) were located in the ascending or genu segment of the cavernous internal carotid artery (ICA). Among the 24 patients (80%) who underwent successful embolization, the ICA was preserved in 23 out of 24 patients (95.8%). The remaining patient had ICA occlusion but exhibited no clinical symptoms. Residual cavernous aneurysm was found in two patients, one patient had persistent cranial nerve deficit, while the other was asymptomatic. Statistical analysis demonstrated a significant difference was associated with the fistula location at the ascending or genu segment of the cavernous ICA in relation to successful embolization <b>Conclusion</b>  Despite the availability of several endovascular treatment options for TCCF, using detachable balloon embolization is a relatively straightforward procedure. When combined with a thorough understanding of cavernous sinus anatomy, this approach can significantly enhance the occlusion rate and preserve ICA patency while minimizing complications, particularly when the fistula is located at the ascending or genu segment of the cavernous ICA.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 2","pages":"330-336"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Intraoperative Ultrasound in Surgical Management of Lhermitte-Duclos Disease: A Case Report.","authors":"Parth Parikh, Naren Nayak, Shubham Goyal, Neelanjana Ghosh, Rahul Pandey","doi":"10.1055/s-0045-1805088","DOIUrl":"10.1055/s-0045-1805088","url":null,"abstract":"<p><p>Lhermitte-Duclos disease (LDD) is a rare, autosomal dominant, dysplastic gangliocytoma of the cerebellum. It is a slow-growing benign tumor. The challenges in the surgical resection of these tumors lie in accurately delineating the tumor margin from the normal cerebellar parenchyma. Intraoperative ultrasound has the potential to overcome these limitations. A 30-year-old woman was diagnosed as having LDD showing a typical \"tigroid\" appearance on MRI. Intraoperative ultrasound was used to delineate the tumor margins and near-total resection was done via right suboccipital craniectomy. The diagnosis was confirmed on histopathological examination. Postoperatively there were no neurological deficits, and the patient is on regular follow-up for screening of Cowden's syndrome. We report this case to highlight the undervalued utility of intraoperative ultrasonography while dealing with patients with LDD. This modality serves as an effective tool to maximize the extent of resection without adding to postoperative morbidity.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 2","pages":"413-416"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exoscopic Supraorbital Keyhole Approach for Skull Base Lesions: An Institutional Experience.","authors":"Bhanu Pratap Singh Chauhan, Ketan Hedaoo, Vijay Parihar, Jitin Bajaj, Shailendra Ratre, Mallika Sinha, M N Swamy, Mukesh Sharma, Jayant Patidar, Y R Yadav","doi":"10.1055/s-0045-1805087","DOIUrl":"10.1055/s-0045-1805087","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;  In recent times, the supraorbital approach via eyebrow incision has gained tremendous popularity in targeting the anterior skull base and few middle cranial fossa lesions, over the more traditional pterional and frontotemporal approaches. However, the extremely narrow viewing angle through this approach requires frequent adjustments of the operating table and microscope for optimal visualization. Illumination via such a small opening in such deep-seated location was another limiting factor. Keeping these problems and cumbersomeness of microscope in mind, experienced surgeons gradually shifted over to purely endoscopic or endoscope-assisted supraorbital keyhole approaches. But it was also limited due to high cost, steep learning curve, and difficulties faced in blood-filled cavities. To circumvent these limitations of the microscope and endoscope, the supraorbital keyhole approach can be accomplished with an exoscope (ExSOKHA). Although various cranial procedures using exoscope have become well established in contemporary times, there is paucity of studies and literature dedicated specifically to this minimally invasive supraorbital keyhole approach using the exoscope only. Here, we aim to study the feasibility and usefulness of the exoscope in targeting skull base lesions via the supraorbital keyhole approach to determine if it can be used in learning while transitioning from the microscope to the endoscope, with the primary objective being the user friendliness of the exoscope in the SOKHA technique. &lt;b&gt;Materials and Methods&lt;/b&gt;  This prospective observational study was conducted in the department of neurosurgery over a period of 7 years. The sample size was 50. The study utilized an exoscope and support arm-2D VITOM rigid-lens telescope (Model 28095 VA, Karl Storz Endoscopy, Tuttlingen, Germany) with a 10-mm outer diameter and a shaft length of 14 cm, light source (Xenon Nova 300, Karl Storz GmBH and Co., Tuttlingen, Germany), camera head, video display monitor, and a holding arm. &lt;b&gt;Results&lt;/b&gt;  Out of 50 cases, the majority were pituitary adenomas (30%) and meningiomas (38%), with aneurysms comprising 6%; only 4 cases (8%) had inadvertent frontal sinus opening and 2 cases (4%) had postoperative cerebrospinal fluid (CSF) leak. The duration of surgery ranged from 2 to 4 hours, with the shortest being for aneurysm clipping/CSF rhinorrhea and the longest for meningioma and pituitary adenoma excision. Intraoperatively, exoscope repositioning for adjustment was required for a maximum of nine times, which significantly reduced the overall operative time. Eight cases had near total excision; the remaining tumors had complete excision and the aneurysms had complete clipping. Hospital stay ranged from 4 to 7 days, with mean intensive care unit (ICU) stay of 3 days. None of the patients had any surgical cosmetic deformity. The Glasgow Outcome Scale of all patients was good (4/5 or 5/5). Thus, ExSOKHA offered good results in term","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 2","pages":"350-356"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Rare Presentation of Traumatic Intracranial Hypotension: A Case Report.","authors":"Satya Bhusan Senapati, Abhijit Acharya, Ranjan Kumar Mohanty, Sumirini Puppala","doi":"10.1055/s-0045-1806730","DOIUrl":"10.1055/s-0045-1806730","url":null,"abstract":"<p><p>Cerebrospinal fluid (CSF) provides buoyant support to the brain and spinal cord. According to the Monroe-Kellie doctrine, confined space in the cranium causes any change in CSF volume contributing to significant intracranial pressure changes, which cause a variety of pathologies and symptoms. We, hereby, present a case of a 33-year-old gentleman who after a motorcycle road traffic accident came to us complaining of persistent headache and neck pain with subdural hematoma (SDH) like presentation, clinically and radiologically, but was reevaluated and diagnosed as traumatic intracranial hypotension and successfully managed surgically after that. Hygromas are believed to be compensatory enlargement of the subdural space due to the loss of CSF volume. The true mechanism of the development of SDH or hygroma due to intracranial hypotension is yet to be hypothesized but provisionally described by a rupture of the bridging veins by being pulled away from the dura because of the low intracranial pressure (ICP) and brain descent. Many prior cases in the literature are shown to have treated the patient with immediate burr hole and decompression of SDH, but this paradoxically worsens the patient due to further lowering of ICP. The causes of prolonged postconcussion headaches are often unidentified, of which intracranial hypotension caused by a CSF leak is potentially under-recognized. In such cases, bilateral SDH with mass effect must be ruled out of any CSF leak before attempting the lifesaving decompressive surgery, as it may paradoxically lead to further morbidity and mortality of the patient.</p>","PeriodicalId":94300,"journal":{"name":"Asian journal of neurosurgery","volume":"20 2","pages":"427-430"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}