Surgical management of acute subdural haematomas in elderly: report of a single center experience

Benedetto, Nicola; Gambacciani, Carlo; Montemurro, Nicola; Morganti, Riccardo; Perrini, Paolo

doi:10.1080/02688697.2016.1244249

Cited by 42 publications

(45 citation statements)

References 12 publications

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“…In patients with a history of cranial operation, textiloma (although no pathognomonic radiologic characteristics are defined for these lesions) should be taken into account in the differential diagnosis when a hyperdense mass lesion is found after surgery, as it is believed that they are much more common than reported [23]. Gelatin sponge, oxidized cellulose, oxidized regenerated cellulose, and microfibrillar collagen, if properly used, are excellent and essential tools for safe control of minor bleeding in neurosurgery.…”

Section: Resultsmentioning

confidence: 99%

Postoperative Textiloma Mimicking Intracranial Rebleeding in a Patient with Spontaneous Hemorrhage: Case Report and Review of the Literature

Montemurro

Murrone²,

Romanelli³

et al. 2020

Case Rep Neurol

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During craniotomy, hemostatic materials such as oxidized cellulose and cotton pads, commonly used to control bleeding, may cause a granulomatous reaction that may produce spaceoccupying mass lesions termed textiloma (or gossypiboma). We present a 46-year-old female who underwent a right frontotemporal craniotomy and surgical removal of intraparenchymal cerebral hemorrhage, and who developed a textiloma during the postoperative period causing seizures. Granulomatous reactions due to hemostatic agents have been reported experimentally, as well as after cranial and spinal operations. We emphasize that although it is rare, an adverse reaction such as a postoperative textiloma due to hemostatic material and subsequent granuloma formation can result in a false image of rebleeding, tumor recurrence, radiation necrosis, or postoperative abscess, depending on the particular clinical history of each patient.

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Section: Resultsmentioning

confidence: 99%

Postoperative Textiloma Mimicking Intracranial Rebleeding in a Patient with Spontaneous Hemorrhage: Case Report and Review of the Literature

Montemurro

Murrone²,

Romanelli³

et al. 2020

Case Rep Neurol

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“…11 Regardless of the surgical technique, age and Glasgow Coma Scale Score appear to be the most important predictors of outcome. 1,2,4 The choice of the operative technique is influenced by the surgeon's expertise, training, and the particular situation. 1,11 Endoscopic approaches have been used to treat subdural pathologies such as subdural empyema and chronic SDHs.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The hematoma is typically treated via a large decompressive craniectomy or craniotomy 2,3 that often leads itself to postoperative morbidity, especially in older adults. 4 Minimally invasive surgical techniques may be preferable in this group of patients.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

Hwang

Shin

2019

J Neurol Surg A Cent Eur Neurosurg

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Background Endoscopic surgery is helpful in evacuating intracranial hematomas. However, the indication and the craniotomy location are still unclear in the endoscopic evacuation of acute subdural hematomas (SDHs). This study evaluated the feasibility and efficacy of endoscopic treatment of acute SDH via a normal small craniotomy. Methods A normal small craniotomy (∼ 3 × 4 cm) as a surgical window was made at the superior temporal line around the coronal suture on the lesion side. A 4-mm rigid endoscope with a 0-degree lens was introduced into the subdural space, and the hematoma was evacuated using irrigation and suction devices with various angles. Endoscopic surgery was performed in 13 older adult patients with acute SDH. Adequacy of the hematoma evacuation, bleeding control, and clinical outcomes were analyzed. Results The mean age of the patient was 78.6 years (range: 65–89 years). Four cases of cortical arterial bleeding were encountered and controlled with bipolar cauterization. No re-bleeding was observed postoperatively in any patient. Near-total hematoma removal was achieved. Remnant hematoma was scanty and located in the parietal area. No further craniectomy was required after the endoscopic surgery. The outcome at discharge was closely related to the patient's level of consciousness before the operation. Conclusion A small craniotomy around the superior temporal line provides an optimal window to evacuate an acute SDH and achieve hemostasis using an endoscope. Endoscopic evacuation of acute SDHs could be effective in selected cases.

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“…The 75% unfavourable outcome rate (64% mortality) in our study is similar to most previously published series (Table 5). 2,4,5,[10][11][12][13][14][15][16][17][18][19][20] The high percentage of favourable outcome and concomitant low 2 (13) a 1 missing. aSDH: acute subdural hematoma, hrs: hours, GCS: Glasgow Coma Scale score, GOS: Glasgow Outcome Scale score, IQR: interquartile range, n: number of patients, saSDH: subacute subdural hematoma, SD: standard deviation.…”

Section: Literature Reviewmentioning

confidence: 99%

Do older patients with acute or subacute subdural hematoma benefit from surgery?

Bus

Verbaan

Kerklaan

et al. 2018

British Journal of Neurosurgery

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Purpose: According to the international guidelines, acute subdural hematomas (aSDH) with a thickness of >10 mm, or causing a midline shift of >5 mm, should be surgically evacuated. However, high mortality rates in older patients resulted in ongoing controversy whether elderly patients benefit from surgery. We identified predictors of outcome in a single-centre cohort of elderly patients undergoing surgical evacuation of aSDH or subacute subdural hematoma (saSDH). Materials and methods: This retrospective study included all patients aged !65 years undergoing surgical evacuation of aSDH/saSDH from 2000 to 2015. One-year outcome was dichotomized into favourable (Glasgow Outcome Scale (GOS) 4-5) and unfavourable (GOS 1-3). Predictors of outcome were identified by analysing patient characteristics. Results: Eighty-four patients aged !65 years underwent craniotomy for aSDH/saSDH during the 16 year time period. Twenty-five percent regained functional independence, 11% survived severely disabled, and 64% died. Most patients died of respiratory failure following withdrawal of artificial respiration or following restriction of treatment. Age of the SDH or Glasgow Coma Scores 8/intubation did not predict unfavourable outcome. All patients with bilaterally absent pupillary light reflexes died, also those who still exhibited one normal-sized pupil. Conclusion: The low number of operated patients per year probably suggests that this cohort represents a selection of patients who were judged to have good chances of favouring from surgery. Functional independence at one-year follow-up was reached in 25% of patients, 64% died. Patients with bilaterally absent pupillary light reflexes did not benefit from surgery. The tendency to restrict treatment because of presumed poor prognosis may have acted as a self-fulfilling prophecy.

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Surgical management of acute subdural haematomas in elderly: report of a single center experience

Abstract: Our study confirms a poor outcome for patients of 70 years and over who received surgical treatment for traumatic aSDH.

Cited by 42 publications

References 12 publications

Postoperative Textiloma Mimicking Intracranial Rebleeding in a Patient with Spontaneous Hemorrhage: Case Report and Review of the Literature

Postoperative Textiloma Mimicking Intracranial Rebleeding in a Patient with Spontaneous Hemorrhage: Case Report and Review of the Literature

Endoscopic Treatment of Acute Subdural Hematoma with a Normal Small Craniotomy

Do older patients with acute or subacute subdural hematoma benefit from surgery?

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