In this study we are trying to establish a correlation between the surgical technique used for the treatment of chronic subdural hematomas and the risk of recurrence. Between 01.06.2008 and 31.05.2014, 123 patients with 138 chronic subdural hematomas (CSDH) were operated on and followed-up in our department. Among them, 16 hematomas (11,6%) recurred. Factors related to the patients (gender, age, location of the hematoma) are analyzed as possible predictors of recurrence. Several surgical techniques were used in the treatment of chronic subdural hematomas. Each of them is analyzed to find possibly connections with the recurrence risk of the size of the approach, the reposition of the bone flap, the suture of the dura and other aspects. There are obvious, statistically significant correlations between the risk of recurrence and some elements of the surgical technique employed.

Objective: Posttraumatic extracerebral fluid collections represent a heterogeneous group of conditions that have different terminologies but the same clinical and imaging features, benefiting from the same therapeutic modalities. Between hygroma/hydroma and serous meningitis there is only a topographic difference that has no influence regarding the therapeutic decision or the patient’s outcome. Posttraumatic extracerebral fluid collections present themselves as a unitary group which benefits from a unitary management, regardless the given terminologies. This 5 years study reviews the experience, treatment and outcome of patients with such conditions. Method: A retrospective analysis of data collected from 46 patients with posttraumatic extracerebral fluid collections is presented. Asymptomatic patients or those with mild symptoms were conservatively treated (n=27). Surgical evacuation was performed in cases of intracranial hypertension or neurological worsening (n=19). Results: Clinical results are presented using the Glasgow Outcome Scale (GOS). Regarding the group of patients treated conservatively, good results were obtained (GOS score 4 or 5) in 81.4 % of the cases. Regarding the surgical treated group of patients, good results were obtained in 73.6% of the cases. The mortality rate was 18.5%, and 26.3% respectively. Conclusions: Although several different names can be found in literature, posttraumatic extracerebral fluid collections present themselves as a unitary group, with good outcome after conservative or surgical treatment. The therapeutic decision is made regarding the neurological status and the clinical evolution, which can be correlated with some imaging features.

Background: Chronic subdural hematomas (CSDHs) are one of the most common intracranial lesions treated in a neurosurgical department. They associate significant morbidity and mortality that increase in the case of recurrences requiring reoperation. Despite extensive published literature, there is still significant debate regarding optimal management of CSDHs and their potential recurrence. Objective: Identify factors for recurrence requiring reoperation of CSDHs in order to adjust our management strategies. Methods: A retrospective review of 64 cases harbouring 71 CSDHs that were surgically treated in the Neurosurgery Department of “Saint Pantelimon” Clinical Emergency Hospital over a period of two years (January 2016 - December 2017). Two main surgical techniques were used: small trephine and large bone flap craniotomy, according to the operating surgeon’s preference. CT scans were performed at admission and 24 hours postoperatively. Postoperative management was similar in all cases. Results: Recurrence requiring reoperation (RrR) was encountered in 16 (25%) of the reviewed cases. Reoperation was found to be significantly more often encountered in particular preoperative CT characteristics: laminar type (RrR=38,10%, p=0.027) and maximal thickness above 22 mm (43,75%, p = 0,013). Surgical technique had a substantial impact on recurrence: in trephinated cases, reoperation was required in only 8 of 51 patients (RrR=15,69%, p = 0.007), while large bone flap craniotomy associated a RrR of 61,54% (p = 0.008), which increased when associated with inner membranectomy (RrR=87,5%, p = 0,007) or subdural drain placement (88,89%, p = 0.007). Reoperations not only doubled the neurosurgical hospital length of stay, but also associated higher perioperative mortality rates (18.75% versus 14,58%). Conclusions: In our series, surgical technique had a decisive impact on the rate of recurrence. CSDH surgery is another example of “in medio stat virtus”, where finding the right balance between the least and most aggressive technique has the potential of providing the best outcomes, and thus small trephination could be taken into consideration.

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Introduction: Remote cerebellar hemorrhage is an infrequent complication, potentially harmful with an unclear etiologic mechanism. There may be incriminated multiple risk factors: arterial hypertension, use of antiplatelet medication (Aspenter), CSF aspiration or drainage associated with intracranial hypotension. Material and methods: We present a 69 year old woman with remote intracerebral hemorrhage that occurred after frontal parasagittal meningioma resection. Results: An inadequate oral hydration was responsible for decreased level of consciousness, cerebellar and parietaloccipital cortical-sub-cortical contra-lateral hemorrhages. Close monitoring of water balance and adequate hydration is related to clinical improvement and resolution of brain imaging. Conclusion: Retraction of the brain due to intracranial hypotension led to some small vessels rupture and development of remote cerebellar hemorrhage.