Effectiveness of Surgical Treatments for Basal Ganglia Hemorrhage and Imaging Factors Affecting Hematoma Evacuation Rate by Neuroendoscopic Surgery

2019 ◽  
Vol 81 (02) ◽  
pp. 155-162
Author(s):  
Ai-Shun Guo ◽  
Guo-Shi Lin ◽  
Da-Hua Xie ◽  
Yan Huang ◽  
Chang-Fu Zhou ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Burr Hole ◽  
Imaging Features ◽  
Independent Factor ◽  
Hematoma Evacuation ◽  
Evacuation Rate ◽  
Neuroendoscopic Surgery ◽  
Significant Difference ◽  
Basal Ganglia Hemorrhage ◽  
Surgical Treatments

Abstract Background Basal ganglia hemorrhage (BGH) is a devastating neurologic disease with high morbidity and mortality, and its management is still controversial. We evaluated the effectiveness of surgical treatments for BGH and investigated computed tomography (CT) imaging features affecting the hematoma evacuation rate (ER) in patients treated with neuroendoscopic surgery. Materials and Methods A total of 104 BGH patients who underwent craniotomy, burr-hole drainage, or neuroendoscopic surgery were analyzed retrospectively. Clinical characteristics, imaging features, and postoperative complications were compared. Univariate and multivariate regression analyses were applied to identify imaging factors associated with ER. Results A significant difference in ER was observed: 78.4% in patients treated with neuroendoscopic surgery, 33.6% in patients treated with burr-hole drainage, and 82.5% in patients treated with craniotomy (p < 0.001). Similar results were observed for operative time (p < 0.001). Five cases (12.5%) of rebleeding were found in patients treated with burr-hole drainage (p = 0.020). No significant difference was found for pneumonia, intracranial infection, gastrointestinal bleeding, hospital mortality, hospital stay, expenses, 3-day Glasgow Coma Scale (GCS) scores after surgery, or GCS at discharge. The CT imaging feature, the island sign (p = 0.004), was observed as an independent factor correlated with lower ER for neuroendoscopic surgery. Conclusions The benefits and drawbacks of surgical treatments confirmed they have their own indications, and neuroendoscopic surgery may be relatively beneficial for BGH treatment. The island sign was an independent factor affecting ER for neuroendoscopic surgery. Therefore, comprehensive assessment of clinical data, especially the island sign, should be performed preoperatively in BGH patients.

Abstract TP20: Prediction of Hemorrhagic Transformation After Endovascular Thrombectomy by Cerebral Blood Volume and Time to Reperfusion

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Tomohide Yoshie ◽  
Toshihiro Ueda ◽  
Tatsuro Takada ◽  
Shinji Nogoshi ◽  
Satoshi Takaishi ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Blood Volume ◽  
Endovascular Therapy ◽  
Cerebral Blood Volume ◽  
Hemorrhagic Transformation ◽  
Cortical Region ◽  
Early Reperfusion ◽  
Endovascular Thrombectomy ◽  
Significant Difference ◽  
Basal Ganglia Hemorrhage

Introduction: Previous studies suggested that low cerebral blood volume (CBV) lesion predicts hemorrhagic transformation after endovascular therapy. Hypothesis: We assessed the hypothesis that delays in time to reperfusion lead to hemorrhagic transformation on T2*-weighted MRI after endovascular therapy in patients with low CBV obtained from pre-treatment CT perfusion (CTP). Methods: We retrospectively analyzed 62 consecutive patients with acute ischemic stroke who were obtained successful reperfusion (TICI 2A-3) by endovascular thrombectomy for internal carotid artery or M1 occlusion. CTP maps were assessed for relative CBV (rCBV) values obtained separately for cortical and basal ganglia regions in the MCA territory. The presence of cortical and basal ganglia hemorrhage (either HI or PH) was assessed on T2*-weighted MRI after endovascular therapy. We analyzed the influence of rCBV in each region, CTP-to-reperfusion time and degree of reperfusion on cortical and basal ganglia hemorrhage. Results: Forty patients developed hemorrhagic transformation. HIs occurred in 16, PH1s in 21, PH2s in 3 and symptomatic hemorrhage in 1 of the patients. rCBV of the cortical region (0.77 versus 0.98, P=0.002) and basal ganglia region (0.64 versus 0.88, P<0.001) were significantly lower in the patients with hemorrhage than in those without. There was no significant difference in CTP-to-reperfusion time between cortical hemorrhage and no cortical hemorrhage groups. However, in the patients with low cortical rCBV (rCBV <0.8) and TICI ≥2b, mean CTP-to-reperfusion time was significantly shorter (70 versus 108 minutes, p=0.021) in the non-cortical hemorrhage group. There was no significant difference in CTP-to-reperfusion time between basal ganglia hemorrhage and non-basal ganglia hemorrhage groups. Conclusions: Early reperfusion decreases risk of cortical hemorrhage in patients with low cortical rCBV. Low rCBV in basal ganglia region is more predictive of basal ganglia hemorrhage than time to reperfusion.

scholarly journals Role of Intraoperative ICP And CPP Measurement for Predicting Surgical Outcome in Severe Traumatic Brain Injury

2020 ◽  
Vol 17 (02) ◽  
pp. 121-129
Author(s):  
Ramesh Chandra VV ◽  
Chandra Mowliswara Prasad Bodapati ◽  
Rajesh Paradesi
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Roc Curves ◽  
Prognostic Indicator ◽  
Burr Hole ◽  
Prognostic Indicators ◽  
Hematoma Evacuation ◽  
Significant Difference ◽  
Severe Tbi ◽  
Causes Of Mortality

Abstract Introduction Traumatic brain injury (TBI) is one of the leading causes of mortality and disability worldwide, and optimizing the management of these patients is a continuing challenge. Intraoperative intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were evaluated for use as prognostic indicators after surgery for severe TBI. Although ICP and CPP monitoring is standard postsurgery treatment for TBI, very few studies have reported the use of ICP and CPP values monitored during surgery. Objectives The objectives of this study were to evaluate the use of intraoperative ICP and CPP values as prognostic indicators and as subjective guidelines for managing severe TBI. Materials and Methods All patients with severe TBI who underwent surgical decompression and ICP monitoring intraoperatively were included in our study from 2017 to 2018. We measured ICP and CPP values after creation of the first burr hole, after hematoma evacuation, and after wound closure. Results From the analysis of receiver-operated characteristic (ROC) curves, we observed that ICP initial (cutoff > 28 mm Hg) and CPP initial (cutoff < 44.5 mm Hg) are the best predictors of unfavorable outcomes. Favorable outcome (Glasgow outcome scale [GOS] 4 and 5) and unfavorable outcome (GOS 1–3) after 6 months were achieved in 64.1 and 35.8% of patients, respectively. There was significant difference between the ICP and CPP values which are measured after the first burrhole, after hematoma evacuation, and after scalp closure in both favorable and unfavorable outcomes. The highest positive Pearson’s correlation coefficient is found between GOS and ICP and CPP after first burr hole. Conclusion Monitoring ICP and CPP during surgery improves management in patients with severe TBI and provides an early prognostic indicator in such patients.

Imaging diagnosis of basal ganglia germ cell tumors: subtype features subtype imaging features of GCTs

2021 ◽  
pp. 20201453
Author(s):  
Wei Li ◽  
Xin Kong ◽  
Jun Ma
Keyword(s):  
Basal Ganglia ◽  
Germ Cell ◽  
Wallerian Degeneration ◽  
Germ Cell Tumors ◽  
Imaging Features ◽  
Adc Value ◽  
Apparent Diffusion Coefficients ◽  
Significant Difference ◽  
Solid Part ◽  
Ct Density

Objectives: To evaluate the subtype imaging features of basal ganglia germ cell tumors (GCTs). Methods: Clinical and imaging data of 33 basal ganglia GCTs were retrospectively analyzed, including 17 germinomas and 16 mixed germ cell tumors (MGCTs). Results: The cyst/mass ratio of germinomas (0.53 ± 0.32) was higher than that of MGCTs (0.28 ± 0.19, p = 0.030). CT density of the solid part of germinomas (41.47 ± 5.22 Hu) was significantly higher than that of MGCTs (33.64 ± 3.75 Hu, p < 0.001), while apparent diffusion coefficients (ADC, ×10-3 mm2/s) value of the solid part was significantly lower in geminomas (0.86 ± 0.27 ×10-3 mm2/s) than in MGCTs (1.42 ± 0.39 ×10-3 mm2/s, p < 0.001). MGCTs were more common with intratumoral hemorrhage (68.75% vs 11.76%, p = 0.01), T1 hyperintense foci (68.75% vs 5.88%, p < 0.001) and calcification (64.29% vs 20.00%, p = 0.025) than germinomas. There was no significant difference in internal capsule involvement between the two subtypes (p = 0.303), but Wallerian degeneration was more common in germinomas than in MGCTs (70.59% vs 25.00%, p = 0.015). Conclusion: The subtypes of GCT have different imaging features. Tumoral cystic-solidity, heterogeneity, ADC value, CT density, and Wallerian degeneration are helpful to differentiate germinomas and MGCTs in basal ganglia. Advances in knowledge: The subtypes of GCT have different histological characteristics, leading to various imaging findings. The imaging features of GCT subtypes in basal ganglia may aid clinical diagnosis and treatment.

scholarly journals POS1288 TUBERCULOUS SPONDYLODISCITIS IN ELDERLY: EPIDEMIOLOGY, CLINICAL, FEATURES, TREATMENT AND OUTCOMES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 926.1-926
Author(s):  
M. Mrabet ◽  
S. Boussaid ◽  
S. Jemmali ◽  
H. Sahli ◽  
H. Ajlani ◽  
...  
Keyword(s):  
Clinical Features ◽  
The Elderly ◽  
Lumbar Pain ◽  
Elderly Subjects ◽  
Normocytic Anemia ◽  
Imaging Features ◽  
X Rays ◽  
Significant Difference ◽  
Young Subjects ◽  
Tuberculous Spondylodiscitis

Background:Tuberculosis is still endemic all over the world. The incidence of tuberculous spondylodiscitis (TS) is steadily increasing. Clinical features and outcomes of this affection are various and depending on various parameters, including age.Objectives:Our objective was to explore the differences in presentation and the results of further investigations and the prognosis of TS between young and elderly subjects.Methods:We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from files of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with TS. We carried out a comparative study concerning the clinical biological, imaging features and outcomes between young subjects and subjects aged over 65 years.Results:Fifty-two cases of TS were collected (37F/15M). The mean age of the population was 55.21 years ± 17.79 [19-91]. Thirty-three patients (69.2%) were classified as young versus 16 elderly patients (30.8%), with female predominance in both groups (69.4% and 75% respectively, p = 0.57). Young subjects was more frequently vaccinated (88.9%) by Bacillus Calmette–Guérin (BCG) (p < 0.001). A delayed diagnosis was noted in both groups (p = 0.24). Lumbar spine involvement was the most common (57.7%). In the two age ranges, the onset of the disease was progressive (p = 0.22), characterized by segmental spine stiffness (p = 0.57) and lumbar pain with general signs (p = 0.27), such as: impaired general condition, fever, night sweats and weight loss. Biological inflammatory syndrome and normochrome normocytic anemia were encountered in both cases (p = 0.08 and p = 0.2, respectively). Standard X-rays and Computed tomography were more performed in young subjects (94.4% and 69.4%, respectively; p < 0.001), unlike magnetic resonance imaging which was more common in elderly subjects but with no statistically significant difference (p = 0.22). Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs (82.7%, 65.4% and 67.3%, respectively). Clinical, biological and imaging arguments contributed to positive diagnosis in both groups (p = 0.24). Common medical treatment was anti-tuberculosis: Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E) and physical treatment such as immobilization witch was more common in the eldery (56.3%, p = 0.16). The evolution of the disease was characterized by a clear improvement of young subjects during the second week of treatment (p < 0.001). A more frequent clinical improvement in older subjects was during the fourth week but with no statistically significant difference (p = 0.13). The occurrence of immediate complications was more frequent in the elderly (p = 0.23) with a predominance for drug complications (56.3%) such as: hepatic cytolysis (12.5%), hyperuricemia (18.8%) and major intolerance to anti-tuberculosis (18.8%).Conclusion:TS is a frequent condition that needs to be treated rapidly. the clinical presentation of TS in the elderly is less noisy which leads to more frequent complications and mortality.Disclosure of Interests:None declared

A minimally invasive anterior skull base approach for evacuation of a basal ganglia hemorrhage

2015 ◽  
Vol 22 (11) ◽  
pp. 1816-1819 ◽  
Author(s):  
Dale Ding ◽  
Colin J. Przybylowski ◽  
Robert M. Starke ◽  
R. Sterling Street ◽  
Amber E. Tyree ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Minimally Invasive ◽  
Skull Base ◽  
Anterior Skull Base ◽  
Base Approach ◽  
Skull Base Approach ◽  
Basal Ganglia Hemorrhage

Effect of acetylsalicylic acid usage and platelet transfusion on postoperative hemorrhage and activities of daily living in patients with acute intracerebral hemorrhage

2013 ◽  
Vol 118 (1) ◽  
pp. 94-103 ◽  
Author(s):  
Xiaowei Li ◽  
Zhaosheng Sun ◽  
Wangmiao Zhao ◽  
Jinrong Zhang ◽  
Jianchao Chen ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Mortality Rate ◽  
Activities Of Daily Living ◽  
Acetylsalicylic Acid ◽  
Daily Living ◽  
Controlled Trial ◽  
Postoperative Hemorrhage ◽  
Basal Ganglia Hemorrhage ◽  
Hemorrhage Volume ◽  
Apheresis Platelets

Object The authors evaluated the effects of acetylsalicylic acid (ASA) usage and transfusion of previously frozen apheresis platelets on postoperative hemorrhage, activities of daily living (ADL) score, and mortality rate in patients with acute hypertensive basal ganglia hemorrhage undergoing craniotomy. Methods This was a prospective, double-blind, parallel, randomized controlled trial in patients with acute hypertensive basal ganglia hemorrhage, who had either not received ASA therapy (control) or received ASA therapy. The patients who received ASA therapy were divided according to the results of a platelet aggregation test into ASA-resistant, ASA-semiresponsive, and ASA-sensitive groups. All patients required an emergency craniotomy for hematoma removal after hospitalization. The patients who were sensitive to ASA were randomized to receive one of the following transfusion regimens of previously frozen apheresis platelets: no transfusion, 1 therapeutic dose before surgery, or 2 therapeutic doses (1 before surgery and 1 after 24 hours of hospitalization). The postoperative hemorrhage rate and the average postoperative hemorrhage volume were recorded and the ADL scores and mortality rate were measured during a 6-month follow-up period. Results The rate of postoperative hemorrhage, average postoperative hemorrhage volume, and mortality rate were significantly higher in the ASA-sensitive patients who received ASA therapy compared with patients who did not receive ASA therapy (all p < 0.005). The ADL scores were grouped into different grades and the number of cases in the lower grades was higher and the overall scores were poorer in patients who received ASA therapy compared with those who did not (all p < 0.005). After transfusion of previously frozen apheresis platelets, the postoperative hemorrhage rate, average postoperative hemorrhage volume, and mortality rate of the ASA-sensitive patients were significantly lowered (all p < 0.005), and the ADL scores and their classification level were better than those of patients who did not undergo transfusion (all p < 0.005). Conclusions Transfusion of previously frozen apheresis platelets reduces the rate of postoperative hemorrhage, average postoperative hemorrhage volume, disability rate, and mortality rate in ASA-sensitive patients with acute hypertensive basal ganglia hemorrhage undergoing craniotomy.

Plasma ADAM-10 levels and functional outcome of acute primary basal ganglia hemorrhage

2021 ◽  
Author(s):  
Ma-Jing Feng ◽  
Wei Wang ◽  
Xue-Feng Zhang ◽  
Fang-Fang Che ◽  
Jie Yang ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Functional Outcome ◽  
Basal Ganglia Hemorrhage

scholarly journals Quantitative CT imaging features for COVID-19 evaluation: The ability to differentiate COVID-19 from non- COVID-19 (highly suspected) pneumonia patients during the epidemic period

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0256194
Author(s):  
Shengkun Peng ◽  
Lingai Pan ◽  
Yang Guo ◽  
Bo Gong ◽  
Xiaobo Huang ◽  
...  
Keyword(s):  
Volume Ratio ◽  
Ct Imaging ◽  
Lesion Volume ◽  
Component Ratio ◽  
Imaging Features ◽  
Quantitative Ct ◽  
Epidemic Period ◽  
Significant Difference ◽  
Sensitivity Specificity ◽  
Ct Features

Objectives COVID-19 and Non-Covid-19 (NC) Pneumonia encountered high CT imaging overlaps during pandemic. The study aims to evaluate the effectiveness of image-based quantitative CT features in discriminating COVID-19 from NC Pneumonia. Materials and methods 145 patients with highly suspected COVID-19 were retrospectively enrolled from four centers in Sichuan Province during January 23 to March 23, 2020. 88 cases were confirmed as COVID-19, and 57 patients were NC. The dataset was randomly divided by 3:2 into training and testing sets. The quantitative CT radiomics features were extracted and screened sequentially by correlation analysis, Mann-Whitney U test, the least absolute shrinkage and selection operator (LASSO) logistic regression (LR) and backward stepwise LR with minimum AIC methods. The selected features were used to construct the LR model for differentiating COVID-19 from NC. Meanwhile, the differentiation performance of traditional quantitative CT features such as lesion volume ratio, ground glass opacity (GGO) or consolidation volume ratio were also considered and compared with Radiomics-based method. The receiver operating characteristic curve (ROC) analysis were conducted to evaluate the predicting performance. Results Compared with traditional CT quantitative features, radiomics features performed best with the highest Area Under Curve (AUC), sensitivity, specificity and accuracy in the training (0.994, 0.942, 1.0 and 0.965) and testing sets (0.977, 0.944, 0.870, 0.915) (Delong test, P < 0.001). Among CT volume-ratio based models using lesion or GGO component ratio, the model combining CT lesion score and component ratio performed better than others, with the AUC, sensitivity, specificity and accuracy of 0.84, 0.692, 0.853, 0.756 in the training set and 0.779, 0.667, 0.826, 0.729 in the testing set. The significant difference of the most selected wavelet transformed radiomics features between COVID-19 and NC might well reflect the CT signs. Conclusions The differentiation between COVID-19 and NC could be well improved by using radiomics features, compared with traditional CT quantitative values.

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