Introduction: Entrapped temporal horn (ETH) syndrome is a rare form of localized noncommunicating hydrocephalus, which is often associated with the treatment of lesions around the trigone area (atrium) of the lateral ventricles. So far, only a few cases have been reported in the literature. Thus, we present our experience with the causes and management of patients with ETH syndrome at our institution. Materials and method: We retrospectively analyzed clinical data of 5 patients with ETH syndrome treated at our facility from July 2018 to August 2021. Patients’ data such as age, sex, initial disease, clinical presentation, radiologic diagnosis, treatment, and outcomes were documented and analyzed. Results: Our patients comprise of 3 females and 2 males. Their ages ranged from 42 to 85 years, with a mean age of 62 years. Postoperative adhesions caused ETH in 3 patients while meningioma and intracranial infection cause the ETH in 2 patients, respectively. One patient was treated via craniotomy, 3 patients were treated via shunting while 1 patient was treated conservatively. The ETH resolved in 4 patients, while no resolution was attained in 1 patient. Conclusion: Definitive treatments via craniotomy or shunting were capable of resolving the ETHs, while conservative treatment did not result in spontaneous resolution. Unresected meningioma around the trigone of the lateral ventricle is capable of causing the ETH, contrary to the notion that, infection or postoperative adhesions are the key causes of ETH. Thus, neurosurgeons ought to be on a lookout for ETH when treating lesions around the trigone area of the lateral ventricles.
Background. Chronic subdural hematoma (CSDH) is one of the common clinical intracranial hemorrhagic disorders, accounting for 16%–20% of bilateral CSDH. At present, the surgical treatment of bilateral CSDH mainly includes drilling drainage and neuroendoscopic assistance. The main objective of this paper was to compare the effects of two surgical methods on CSDH. Methods. 153 patients who were diagnosed with CSDH were included in this study. 79 patients were treated with bilateral drilling drainage, and the other 74 patients were treated with neuroendoscope-assisted drainage. The clinical data of the two groups were compared, and the surgical indexes, neurological function, cure rate, and recurrence rate of the two groups were compared. The operation indexes of patients include operation time, postoperative hematoma volume, hospital stay, extubation time, misplacement of drainage tube, recurrence, and hematoma clearance rate. Results. All patients underwent CT examination one day after operation. The CT imaging detection of the two groups was generally good. The cranial CT was reexamined before discharge. The bilateral hematoma disappeared in 114 patients, the unilateral hematoma disappeared in 29 patients, a small amount of compensatory crescent very low-density shadow subdural effusion was observed on the other side, and a small amount of compensatory crescent very low-density shadow subdural effusion was observed on both sides in 10 patients. There was no space occupying effect and intracranial gas disappeared. Compared with neuroendoscopic assisted drainage, the operation time of drilling drainage patients was significantly shorter. The extubation time, drainage tube dislocation, recurrence rate, postoperative hematoma volume, and hematoma clearance rate of patients receiving neuroendoscopic assisted drainage were significantly better than those receiving drilling drainage. The Markwalder score and hospital stay between the two groups were not significant. Conclusions. Drilling drainage and neuroendoscopic assisted surgery have good therapeutic effects on bilateral CSDH. The operation time of drilling drainage is shorter. Neuroendoscopic assisted surgery has more advantages in extubation time, misplacement of drainage tube, recurrence, postoperative hematoma volume, and hematoma clearance rate.
Contrast-induced encephalopathy (CIEP) is a rare complication after endovascular therapy. The etiology of CIEP is still a matter of debate. We present a rare occurrence of CIEP in a known hypertensive and type 2 diabetic patient after endovascular coiling of cerebral aneurysm with oculomotor nerve palsy. A 68-year old female presented with seven days history of headache and left ptosis or blepharoptosis with mild mydriasis. The headaches were localized mainly at the left side of the nose, orbit, and upper forehead while the left ptosis was associated with blurred vision. Computed tomography angiography revealed an aneurysm in between the C4 segment of the left internal carotid artery (ICA) and the bifurcation of the left posterior communicating artery. Digital subtraction angiography further confirmed the aneurysm. We used the transarterial approach to assess the aneurysm and subsequent coiling. Iohexol (Omnipaque) contrast agent was used during the endovascular procedure. The patient’s condition deteriorated into acute confusion state with cardinal symptomology of CIEP immediately after the operation. Computed tomography scan revealed cortical contrast enhancement in the vascular territory of the ICA as well as edema. Her symptomatology resolved 48 hours after treated with anticonvulsants, intracranial pressure reduction and hydration. Chronic hypertension as well as type 2 diabetics may be critical predisposing factors to CIEP. CIEP should be suspected in patients presenting with acute confusion state after endovascular therapy. Massive edema with ischemic brain changes in white matter of the brain before endovascular procedure should rise suspicion of CIEP.
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