abbreviatioNs GCS = Glasgow Coma Scale; mRS = modified Rankin Scale; SDH = subdural hematoma. subMitted April 30, 2014. accepted October 17, 2014. iNclude wheN citiNg Published online April 24, 2015; DOI: 10.3171/2014.10.JNS14915. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Endoscopic hematoma evacuation for acute and subacute subdural hematoma in elderly patientsKimihiko Yokosuka, Md, phd, Masaaki uno, Md, phd, Kohei Matsumura, Md, hiroki takai, Md, hirotaka hagino, Md, Nobuhisa Matsushita, Md, phd, hiroyuki toi, Md, and shunji Matsubara, Md, phd Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan obJect Endoscopic surgery was performed for acute or subacute subdural hematoma (SDH), and its effectiveness and safety in elderly patients were evaluated. Methods Between September 2007 and November 2013, endoscopic surgery was performed in 11 elderly patients with acute SDH (8 patients) and subacute SDH (3 patients). The criteria for surgery were as follows: 1) the presence of clinical symptoms; 2) age older than 70 years; 3) no brain injury (intracerebral hematoma, brain contusion); 4) absence of an enlarging SDH; and 5) no high risk of bleeding. Hematoma evacuation was performed with a 4-mm rigid endoscope with a 0° lens and a malleable irrigation suction cannula. results Endoscopic surgery was performed under local anesthesia. The mean age of the patients was 82.6 years (range 73-91 years). There were 5 female and 6 male patients. The mean preoperative Glasgow Coma Scale score was 12, and 5 patients had been receiving antithrombotic drug therapy. The mean operation time was 85 minutes. Only 1 patient had rebleeding, and reoperation with the same technique was performed uneventfully in this individual. A total of 7 patients had a good recovery (modified Rankin Scale Score 0-2) at discharge. coNclusioNs Endoscopic hematoma evacuation of acute and subacute SDH is a safe and effective method of clot removal that minimizes operative complications. This technique may be a less invasive method for treating elderly patients with acute and subacute SDHs.
Background: Convexity dural arteriovenous fistulae (dAVF) usually reflux into cortical veins without involving the venous sinuses. Although direct drainage ligation is curative, transarterial embolization (TAE) may be an alternative treatment. Case Description: Between September 2018 and January 2021, we encountered four patients with convexity dAVFs. They were three males and one female; their age ranged from 36 to 73 years. The initial symptom was headache (n = 1) or seizure (n = 2); one patient was asymptomatic. In all patients, the feeders were external carotid arteries with drainage into the cortical veins; in two patients, there was pial arterial supply from the middle cerebral artery. All patients were successfully treated by TAE alone using either Onyx or N-butyl cyanoacrylate embolization. Two patients required two sessions. All dAVFs were completely occluded and follow-up MRI or angiograms confirmed no recurrence. Conclusion: Our small series suggests that TAE with a liquid embolic material is an appropriate first-line treatment in patients with convexity dAVFs with or without pial arterial supply.
Endoscopic surgery has become recognized as a less invasive and safe surgery for putaminal hemorrhage. However, the operative technique has remained controversial. The approach for endoscopic surgery for putaminal hemorrhage in our institution was examined.We started performing endoscopic surgery for putaminal hemorrhage in January 2006, and examined 92 patients treated with this approach. A rigid endoscope and irrigation suction were used, with a "Freehand Technique", as previously described. The mean age of patients was 61.1 ± 11.3 years, and the mean hematoma volume was 65.4 ± 27.6 mL. Local anesthesia was used for endoscopic surgery in 66.3% (61/92) of patients. The mean operation time was 89.8 ± 30.2 min, and the mean hematoma removal rate was 94.2 ± 9.7%. The re-bleeding rate was 4.3%, and the rate of mortality caused by rebleeding was 2.2% (2/92).
Summary:The purpose of this study is to suggest a new and simple classification of anterior communicating artery (ACoA) aneurysms based on the relation between A1 direction and aneurysm projection. We analyzed the effect of morphological features on angiographic outcome after coil embolization for ACoA aneurysms.We conducted a retrospective case review of 78 consecutive patients (35 men and 43 women) with ACoA aneurysms treated at our institution from September 2004 to October 2013. The patterns of A1 direction and aneurysm projection allowed the classification of ACoA aneurysms into four types: S-S type, A1 with superior direction and aneurysm with superior projection; S-I type, A1 with superior direction and aneurysm with inferior projection; I-I type, A1 with inferior direction and aneurysm with inferior projection; I-S type, A1 with inferior direction and aneurysm with superior projection. The percentage distribution of each type is as follows: S-S, 28.2%; I-I, 44.9%; S-I, 11.5%; and I-S, 15.4%. The I-I type is the most common type of aneurysm in this classification.Thirty-five patients were treated with endovascular coil embolization, and the average volume embolization ratios were as follows: S-S, 34.2%; I-I, 28.2%; S-I, 25.8%; and I-S, 26.6%. Complete occlusion (Raymond grade 1) was achieved at 90% in S-S, 35.7% in I-I, 42.9% in S-I, and 0% in I-S. The S-S and I-I types are likely to result in complete occlusion or neck remnant. The S-I and I-S types are likely to result in body filling.It is thought that coil embolization was likely to have resulted unfavorably in direction mismatch types (S-I, I-S) because the relation between A1 direction and aneurysm projection directly affects the intraoperative deliverability and stability of the microcatheter.In conclusion, this classification provides useful information for ACoA aneurysm treatment in a simple and immediate manner.
Objective: We report a rare case of sigmoid sinus dural arteriovenous fistula causing brainstem hemorrhage. Case Presentation: The patient was a 77-year-old woman who presented with right hemiparesis. Computed tomography of the head revealed pontine hemorrhage with marked perifocal edema. Cerebral angiography showed a sigmoid sinus dural arteriovenous fistula with drainage to the superior petrosal sinus connecting to the petrosal and transverse pontine veins. Transvenous embolization was successfully performed, resulting in complete occlusion.Conclusion: Brainstem hemorrhage can result from dural arteriovenous fistula. Careful diagnosis is important to avoid inappropriate treatment and adverse events.
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