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decompressive hemicraniectomy

Sang-Beom Jeon, Sun U Kwon, Jung Cheol Park, Deok Hee Lee, Sung-Cheol Yun, Yeon-Jung Kim, Jae-Sung Ahn, Byung-Duk Kwun, Dong-Wha Kang, H Alex Choi, Kiwon Lee, Jong S Kim
BACKGROUND AND PURPOSE: Hemicraniectomy is a decompressive surgery used to remove a large bone flap to allow edematous brain tissue to bulge extracranially. However, early indicators of the decompressive effects of hemicraniectomy are unclear. We investigated whether reduction of midline shift following hemicraniectomy is associated with improved consciousness and survival in patients with malignant middle cerebral artery infarctions. METHODS: We studied 70 patients with malignant middle cerebral artery infarctions (MMI) who underwent hemicraniectomies...
September 2016: Journal of Stroke
Y-S Wang, Y Wang, X-W Shi, J-D Zhang, Y-Y Ma
OBJECTIVE: To verify if the size of the bone flap and the bone window area may have an impact on the outcome of decompressive craniectomy. PATIENTS AND METHODS: From February 2012 to February 2014, 42 patients with acute intracranial hypertension were enrolled in this study. We conducted standard craniotomy and decompressive hemicraniectomy on all patients. The intracranial pressure was measured before the hemicraniectomy operation, at the time of bone flap removal, at the time of the incision of the dura mater and 24 hours after the operation...
September 2016: European Review for Medical and Pharmacological Sciences
P Meneghelli, F Cozzi, A Hasanbelliu, F Locatelli, Alberto Pasqualin
From 1991 until 2013, 304 patients with intracranial hematomas from aneurysmal rupture were managed surgically in our department, constituting 17 % of all patients with aneurysmal rupture. Of them, 242 patents presented with isolated intracerebral hematomas (in 69 cases associated with significant intraventricular hemorrhage), 50 patients presented with combined intracerebral and subdural hematomas (in 11 cases associated with significant intraventricular hemorrhage), and 12 presented with an isolated subdural hematoma...
2016: Acta Neurochirurgica. Supplement
Kirsten E Stoner, Kingsley O Abode-Iyamah, Nicole M Grosland, Matthew A Howard
BACKGROUND: Decompressive craniectomy procedures are performed in patients with malignant intracranial hypertension. A bone flap is removed to relieve pressure. Later a second operation is performed to reconstruct the skull after brain swelling has resolved. This surgical treatment would be improved if it were possible to perform a single operation that decompressed the brain acutely while eliminating the need for a second operation. In order to design a device and procedure that achieves this objective it is essential to understand how the brain swells following a craniectomy procedure...
August 30, 2016: World Neurosurgery
James G Malcolm, Brandon A Miller, Jonathan A Grossberg, Gustavo Pradilla, Faiz U Ahmad
Following craniectomy, hygromas are relatively common. While many cases resolve spontaneously, some patients develop neurologic deficits. Management of symptomatic hygromas often involves shunting or drainage. We present two patients who three weeks after decompressive hemicraniectomy developed declining neurologic status secondary to enlarging hygroma. Failing conservative management, both were treated with urgent cranioplasty and returned to neurologic baseline. Early cranioplasty may be safe and effective for symptomatic collections...
August 11, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Grace Lim, Jamie M Zorn, Yuanxu J Dong, Joseph S DeRenzo, Jonathan H Waters
OBJECTIVE: This report aimed to describe the characteristics and impact of subdural hematoma (SDH) after labor epidural analgesia. CASE REPORTS: Eleven obstetric patients had SDHs associated with the use of labor epidural analgesia over 7 years at a tertiary care hospital. Ten of 11 patients had signs consistent with postdural puncture headache before the diagnosis of SDH. Five patients (45%) had a recognized unintentional dural puncture, 1 (9%) had a combined spinal-epidural with a 24-gauge needle, and 5 (45%) had no recognized dural puncture...
September 2016: Regional Anesthesia and Pain Medicine
Corey R Fehnel, Yoojin Lee, Linda C Wendell, Bradford B Thompson, N Stevenson Potter, Vincent Mor
BACKGROUND: While clinical trial data support decompressive hemicraniectomy (DHC) as improving survival among patients with severe ischemic stroke, quality of life outcomes among older persons remain controversial. AIMS: To aid decision-making and understand practice variation, we measured long-term outcomes and patterns of regional variation for a nationwide cohort of ischemic stroke patients after DHC. METHODS: Medicare fee-for-service ischemic stroke cases over age 65 during the year 2008 were used to create a cohort followed for 2 years (2009-2010) after stroke and DHC procedure...
August 5, 2016: Aging Clinical and Experimental Research
Han-Yeong Jeong, Jun-Young Chang, Kyu Sun Yum, Jeong-Ho Hong, Jin-Heon Jeong, Min-Ju Yeo, Hee-Joon Bae, Moon-Ku Han, Kiwon Lee
BACKGROUND AND PURPOSE: The use of decompressive hemicraniectomy (DHC) for the treatment of malignant cerebral edema can decrease mortality rates. However, this benefit is not sufficient to justify its use in elderly patients. We investigated the effects of therapeutic hypothermia (TH) on safety, feasibility, and functional outcomes in elderly patients with malignant middle cerebral artery (MCA) infarcts. METHODS: Elderly patients 60 years of age and older with infarcts affecting more than two-thirds of the MCA territory were included...
September 2016: Journal of Stroke
Hosam Al-Jehani, Kevin Petrecca, Phillipe Martel, David Sinclair, Denis Sirhan
BACKGROUND: Decompressive hemicraniectomy (DhC) is a life-saving surgical procedure being increasingly employed for malignant middle cerebral artery strokes. We examined the incidence of hemorrhagic transformation following DhC. METHODS: We retrospectively reviewed the charts and radiological images of patients who underwent DhC for malignant middle cerebral artery strokes. We classified the hemorrhagic events and assessed the short-term 30-day outcome associated with these events...
September 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Hormuzdiyar H Dasenbrock, Faith C Robertson, M Ali Aziz-Sultan, Donovan Guittieres, Rose Du, Ian F Dunn, William B Gormley
BACKGROUND: Decompressive hemicraniectomy (DHC) for space-occupying cerebral infarction in older adults remains controversial, and there are limited nationwide data evaluating the outcomes after craniectomy for stroke by patient age. METHODS: Patients who underwent DHC for ischemic stroke were extracted from the Nationwide Inpatient Sample (2002-2011). Multivariable logistic regression examined in-hospital mortality and a poor outcome (death, tracheostomy and gastrostomy, or discharge to institutional care)...
July 12, 2016: Neurocritical Care
Scott Boop, Mary Axente, Blakely Weatherford, Paul Klimo
OBJECTIVE Research on pediatric abusive head trauma (AHT) has largely focused on clinical presentation and management. The authors sought to review a single-institution experience from a public health perspective to gain a better understanding of the local population affected, determine overall incidence and seasonal trends, and provide details on the initial hospitalization, including extent of injuries, neurosurgical interventions, and hospital charges. METHODS All cases of AHT involving patients who presented to Le Bonheur Children's Hospital (LBCH) from 2009 through 2014 were identified...
July 12, 2016: Journal of Neurosurgery. Pediatrics
Hans-Werner Pledl, Carolin Hoyer, Juliane Rausch, Anne D Ebert, Marcel Seiz, Mirko Arp, Michael G Hennerici, Angelika Alonso
BACKGROUND: Decompressive hemicraniectomy (DHC) is life-saving in patients with malignant middle cerebral artery infarction (MMI), but outcome, perspectives and complications after DHC in daily practice are largely unknown. METHODS: From 2008 until 2014, we extracted patient's characteristics as well as complications from our database for patients with MMI who underwent DHC. Additionally, we analysed medical records from the different rehabilitation steps. RESULTS: We identified 48 consecutive patients (mean 57 years, 21 male, 41...
2016: European Neurology
Michael N Diringer
No abstract text is available yet for this article.
August 2016: Neurocritical Care
Michael A Pizzi, David A Alejos, Jason L Siegel, Betty Y S Kim, David A Miller, William D Freeman
BACKGROUND: Cerebral venous thrombosis (CVT) is a rare cerebrovascular event that can present with headache, seizure, and focal neurological deficits. Approximately 30%-40% of patients with CVT also present with intracranial hemorrhage. Current guidelines recommend anticoagulation after CVT even in the setting of intracranial hemorrhage, but the timing of initiation is unclear. We present a case of CVT where timing of anticoagulation was unclear by current guidelines. METHODS: We conducted a literature search with search terms of "cerebral venous thrombosis," "intracranial hemorrhage," and "anticoagulation...
September 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Jaechan Park, Wonsoo Son, Joomi Lee
OBJECTIVE: Although age already is known as a crucial factor affecting the functional outcome after a hemicraniectomy for malignant hemispheric infarction, previous studies have used arbitrary age cut-offs of 50, 60, or 70 years. Therefore, this study investigated predictors of the functional outcome after a hemicraniectomy and attempted to determine the critical age for an unfavorable functional outcome. METHODS: A total of 38 patients with large hemispheric infarction were treated with a decompressive hemicraniectomy and the corresponding 1-year modified Rankin Scale (mRS) data obtained...
September 2016: World Neurosurgery
Nobuhiko Arai, Masanao Tabuse, Akiyoshi Nakamura, Hiromichi Miyazaki
BACKGROUND: The incidence of cerebral venous thrombosis (CVT) is low, and in particular, isolated cortical vein thrombosis (ICVT) is very rare. The diagnosis of ICVT is difficult by using conventional computed tomography (CT) and magnetic resonance imaging (MRI). However, with appropriate treatment, ICVT has a good prognosis. CASE PRESENTATION: Herein, we present a rare case of a 40-year-old woman with ICVT and type II protein S (PS) deficiency, who experienced a stroke...
2016: BMC Neurology
S Honeybul, O Damodaran, C R P Lind, G Lee
Over the past few years there have been a number of case reports and small cohort studies that have described so called "malignant" cerebral swelling following an uneventful cranioplasty procedure. The pathophysiology remains to be established however it has been suggested that it may be related to a combination of failure of autoregulation and the use of closed vacuum suction drainage. The current study presents three further patients who had had a decompressive hemicraniectomy for ischaemic stroke. If decompressive craniectomy is utilised in the management of neurological emergencies, close attention and wider reporting of this type of complication is required not only to focus attention on possible management strategies, but also to determine which patients are at most risk of this devastating complication...
July 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Se Ho Jeong, Ui Seok Wang, Seok Won Kim, Sang Woo Ha, Jong Kyu Kim
OBJECTIVE: Symptomatic epidural fluid collection (EFC) arising as a complication of cranioplasty is underestimated and poorly described. The purpose of this study was to investigate the risk factors for development of symptomatic EFC after cranioplasty following traumatic brain injury (TBI). METHODS: From January 2010 to December 2014, 82 cranioplasties following decompressive hemicraniectomy for TBI were performed by a single surgeon. Of these 82 patients, 17 were excluded from this study due to complications including postoperative hematoma, hydrocephalus, or infection...
April 2016: Korean Journal of Neurotrauma
Alexandra D Beier, Gemi E Jannotta, E Dayan Sandler, Harry S Abram, Raj D Sheth, Philipp R Aldana
Hemiconvulsion-hemiplegia-epilepsy (HHE) is an uncommon epileptic syndrome that affects young children. Typical management includes early initiation of benzodiazepines to abate the initial seizure activity quickly. Patients in whom epilepsy develops require prolonged use of antiepileptic agents. Herniation due to diffuse cerebral edema from HHE is rare; however, decompressive craniectomy has been described as a lifesaving measure. The authors present the case of a patient in whom a decompressive craniectomy was performed...
September 2016: Journal of Neurosurgery. Pediatrics
Hiroyasu Koizumi, Eiichi Suehiro, Yuichi Fujiyama, Hiroshi Yoneda, Hideyuki Ishihara, Sadahiro Nomura, Masami Fujii, Michiyasu Suzuki
The pressure reactivity index (PRx) is calculated as a moving correlation coefficient between intracranial pressure (ICP) and mean arterial blood pressure (MABP), and this analytical value is viewed as reflecting a vasomotor response to MABP variability. At present, the factors influencing the PRx value during the acute stage of traumatic brain injury (TBI) are not known. We observed significant cases where changes in the calculated value of PRx seemed to be influenced by changes in brain temperature during the course of acute stage TBI...
2016: Acta Neurochirurgica. Supplement
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