BackgroundThe mixed density hematoma (MDH) has a high recurrence rate in chronic subdural hematoma (CSDH). This study adopted rigid neuroendoscopy assisted hematoma resection to evacuate CSDH and investigated its efficacy as compared with the traditional burr-hole craniostomy (BHC) in CSDH with mixed density.MethodsA retrospective cohort study was conducted at two centers between January 2015 and December 2020. The data of 124 patients who underwent BHC for CSDH with mixed density were collected and analyzed. A total of 41 patients underwent rigid neuroendoscopy assisted hematoma resection (neuroendoscopy group) and 83 patients were treated by the traditional BHC (control group). Follow-ups were conducted 6 months after the surgery.ResultsThere was no significant difference in the baseline characteristics and preoperative CT features between the two groups (p > 0.05). The neuroendoscopy group had a lower recurrence rate than the control group (p = 0.043). Besides the neuroendoscopy group had a higher rate of hematoma evacuation (p < 0.001), less pneumocephalus volume (p < 0.001), shorter hospital stay (p < 0.001) and better Markwalder score (p < 0.001) than the control group within 24–48 h after operation. However, there was no significant difference between the two groups in the incidence of pneumocephalus, Markwalder score (at discharge and 6 months after surgery) and mortality. Moreover, the operation time was longer in the neuroendoscopy group (p < 0.001).ConclusionsWhen compared with the traditional BHC, rigid neuroendoscopy assisted hematoma resection can better reduce the recurrence rate of CSDH with mixed density. Also, it surpassed the results obtained from BHC in reducing the volume of pneumocephalus, improving hematoma evacuation rate, promoting short-term neurological recovery, and shortening hospital stays.
Purpose: To quantify the size of the giant pediatric intracranial tumor (GPIT), analyze the character of GPIT and optimize the management of GPIT.Materials and methods: This study analyzes the clinical data of 36 cases of GPIT at a center from January 2015 to August 2020. The volume of GPITs were measured by 3D slicer software based on preoperative magnetic resonance imaging (MRI).Result: The mean volume of GPITs is 110.7ml, with the maximum volume 619.8ml and the minimum volume 27.3ml. Hemisphere held the largest mean volume of GPIT among all locations, including 7 cases whose volume is over 100ml. There is no statistical difference in volume of GPIT between sex. The most common sites of GPITs are hemisphere and cerebellum. Other locations include ventricle, sellar-parasellar region and cerebropontine angle. Medulloblastoma is the most common postoperative histopathological type, other types contain ependymoma, pilocytic astrocytoma, atypical teratoid rhabdoid tumor (AT/RT), choroid plexus carcinoma (CPC), choroid plexus papilloma(CPP), oligodendroglioma, primitive neuroectoderm tumor (PNET), immature teratoma and yolk sac tumor. 28 cases achieved total resections while 4 cases only achieved subtotal resections. The patient with giant immature teratoma died during the operation because of bleeding. High-grade malignant tumors indicate poorer prognosis.Conclusion: GPIT is a common disease in children with unfavorable prognosis, especially in high-grade malignant tumors like CPC, PNET and AR/RT. Volume measurement based on MRI is an effective approach to access and compare the sizes of GPITs. Operation can expend the survival periods of the patients. Surgical strategies should be chosen according to the location and pathological feature of the tumors.
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