scholarly journals Management of spontaneous cerebrospinal fluid hypovolemia-associated massive chronic subdural hematoma with reinforced restriction of physical activity: report of three cases

2020 ◽  
Vol 48 (11) ◽  
pp. 030006052096932
Author(s):  
Lanhua Zou ◽  
Guichen Li ◽  
Jinchuan Zhao ◽  
Yang Zhang ◽  
Kun Hou
Keyword(s):  
Physical Activity ◽  
Cerebrospinal Fluid ◽  
General Population ◽  
Subdural Hematoma ◽  
Complete Resolution ◽  
Early Recognition ◽  
Chronic Subdural Hematoma ◽  
Promising Strategy ◽  
Treatment Measures ◽  
Activity Report

Spontaneous cerebrospinal fluid hypovolemia (SCFH) is an uncommon entity in neurosurgical practice. Without early recognition and management, some patients with SCFH can develop chronic subdural hematoma (CSDH). Generally, management of patients with SCFH without CSDH is relatively straightforward. However, this circumstance becomes more complicated in patients with concurrent CSDH. Treatment measures simply based on the respective management principles of SCFH and CSDH are insufficient or even disastrous. Our previous study showed that reinforced restriction of physical activity was a promising strategy in managing CSDH in the general population. We applied this strategy in three consecutive patients with SCFH and massive CSDH. All of the patients experienced complete resolution of CSDH. This study not only enriches the basic theory of formation and progression of CSDH, but also demonstrates that reinforced restriction of physical activity could be treated as an alternative or adjuvant management of CSDH secondary to SCFH.

Cerebrospinal fluid leakage into the subdural space: possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma

2008 ◽  
Vol 108 (2) ◽  
pp. 275-280 ◽  
Author(s):  
Rudolf A. Kristof ◽  
Jochen M. Grimm ◽  
Birgit Stoffel-Wagner
Keyword(s):  
Cerebrospinal Fluid ◽  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Postoperative Recurrence ◽  
Cerebrospinal Fluid Leakage ◽  
Subdural Space ◽  
Subdural Hygroma ◽  
Fluid Leakage ◽  
Csf Leakage

Object The purpose of this study was to clarify whether cerebrospinal fluid (CSF) leakage into the subdural space is involved in the genesis of chronic subdural hematoma (CSDH) and subdural hygroma (SH) and to clarify whether this leakage of CSF into the subdural space influences the postoperative recurrence rate of CSDH and SH. Methods In this prospective observational study, 75 cases involving patients treated surgically for CSDH (67 patients) or SH (8 patients) were evaluated with respect to clinical and radiological findings at presentation, the content of β -trace protein (β TP) in the subdural fluid (βTPSF) and serum (βTPSER), and the CSDH/SH recurrence rate. The βTPSF was considered to indicate an admixture of CSF to the subdural fluid if βTPSF/βTPSER > 2. Results The median β TPSF level for the whole patient group was 4.29 mg/L (range 0.33–51 mg/L). Cerebrospinal fluid leakage, as indicated by βTPSF/βTPSER > 2, was found to be present in 93% of the patients with CSDH and in 100% of the patients with SH (p = 0.724). In patients who later had to undergo repeated surgery for recurrence of CSDH/SH, the βTPSF concentrations (median 6.69 mg/L, range 0.59–51 mg/L) were significantly higher (p = 0.04) than in patients not requiring reoperation (median 4.12 mg/L, range 0.33–26.8 mg/L). Conclusions As indicated by the presence of βTP in the subdural fluid, CSF leakage into the subdural space is present in the vast majority of patients with CSDH and SH. This leakage could be involved in the pathogenesis of CSDH and SH. Patients who experience recurrences of CSDH and SH have significantly higher concentrations of βTPSF at initial presentation than patients not requiring reoperation for recurrence. These findings are presented in the literature for the first time and have to be confirmed and expanded upon by further studies.

Middle meningeal artery embolization for chronic subdural hematoma: an institutional technical analysis

2020 ◽  
pp. neurintsurg-2020-016552
Author(s):  
Joshua S Catapano ◽  
Andrew F Ducruet ◽  
Candice L Nguyen ◽  
Jacob F Baranoski ◽  
Tyler S Cole ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Complete Resolution ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Artery Embolization ◽  
Embolic Material ◽  
Ethylene Vinyl Alcohol ◽  
Single Center Experience ◽  
Meningeal Artery ◽  
Single Branch

BackgroundRecently, middle meningeal artery (MMA) embolization has emerged as a potentially safe and effective method of treating chronic subdural hematoma (cSDH).ObjectiveTo report a single-center experience with MMA embolization and examines the type of embolic material used, the extent of penetration, and the number of MMA branches embolized.MethodsA retrospective analysis of all patients with MMA embolization from 2018 through 2019 was performed. A failed outcome was defined as either surgical rescue and/or greater than 10 mm of hematoma residual or reaccumulation following embolization.ResultsOf 35 patients, surgery had failed for 9 (26%) and initial conservative treatment had failed for 6 (17%). Of 41 MMA embolizations, including those in six patients with bilateral cSDH who underwent bilateral MMA embolization, 29 (72%) were performed using ethylene vinyl alcohol copolymer (Onyx), 7 (17%) using particles, and 5 (12%) using n-butyl cyanoacrylate. Both the anterior and posterior MMA divisions were embolized in 29 cases (71%); distal penetration of these branches was achieved in 25 embolizations (61%). Twenty-six (63%) cSDHs completely resolved. Complete resolution was seen in 22 of 29 hematomas (76%) in which both anterior and posterior MMA branches were occluded versus 4 of 12 (33%) following single-branch embolization (p=0.014). Embolization of one cSDH (2%) failed.ConclusionMMA embolization of cSDHs appears to be both safe and efficacious. Furthermore, embolization of both the anterior and posterior MMA branches may be associated with increased odds of complete resolution.

Production of clinical form of chronic subdural hematoma in experimental animals

1972 ◽  
Vol 37 (5) ◽  
pp. 552-561 ◽  
Author(s):  
Satoru Watanabe ◽  
Hironobu Shimada ◽  
Shozo Ishii
Keyword(s):  
Cerebrospinal Fluid ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Subdural Space ◽  
Clinical Form ◽  
Content Type ◽  
Experimental Animals ◽  
Fine Print

✓ A method for producing a clinical form of experimental chronic subdural hematoma is reported. When blood is mixed with cerebrospinal fluid and incubated, a peculiar clot is formed which, when inoculated into the subdural space of dogs or monkeys, grows gradually. Histologically the capsule of the hematoma is comparable to that seen in human chronic subdural hematoma. In some animals progressive hemiparesis develops.

scholarly journals Giant Subgaleal cerebrospinal fluid leakage: An unusual complication of chronic subdural hematoma surgery

2017 ◽  
Vol 31 (3) ◽  
pp. 316-318
Author(s):  
Luis Rafael Moscote-Salazar ◽  
Hernando Raphael Alvis-Miranda ◽  
Amit Agrawal ◽  
Willem Calderon-Miranda ◽  
Alfonso Pacheco-Hernandez
Keyword(s):  
Cerebrospinal Fluid ◽  
Physical Examination ◽  
Mental Status ◽  
Subdural Hematoma ◽  
Neurological Disorder ◽  
Rare Case ◽  
Chronic Subdural Hematoma ◽  
Cerebrospinal Fluid Leakage ◽  
Unusual Complication ◽  
Fluid Leakage

Abstract We report a rare case of chronic subdural hematoma complicated with a Giant subgaleal cerebrospinal fluid leakage. Physical examination was performed with no alteration in mental status and no focal neurological disorder. The subdural hematoma was drained and two weeks later, patient was admitted to our hospital with a giant scalp swelling. Physical examination revealed a left parietal subcutaneous collection. The patient was reoperated with a correction in the fistula, he presented a satisfactory postoperative evolution. To our knowledge, this is the first report in literature of a chronic subdural hematoma with a complicated giant subgaleal cerebrospinal fluid leakage.

scholarly journals Functional recovery following surgery for chronic subdural hematoma

2020 ◽  
Vol 11 ◽  
pp. 450
Author(s):  
Sarah A. Merrill ◽  
Daniel Khan ◽  
Alexandra E. Richards ◽  
Maziyar A. Kalani ◽  
Naresh P. Patel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Physical Therapy ◽  
Functional Recovery ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Neurological Deficits ◽  
Presenting Symptoms

Background: Among the elderly, chronic subdural hematoma is a relatively common neurosurgical condition. Presenting symptoms range from headache and focal neurological deficits to seizure and coma depending on location and extent of brain compression. Functional recovery following surgery for chronic subdural hematoma is central to quality of life and ongoing health for elderly patients; however, there is a paucity of data regarding functional recovery in this population. Methods: In this study, the physical activity of patients who underwent surgical evacuation of chronic subdural hematoma was surveyed, as well as participation in physical therapy following surgery. In total, 38 patients completed the survey. Results: Of the 30 patients who exercised regularly before surgery, 28 (90.3%) returned to exercise within 1 year after surgery. Of 13 patients who reported playing hobby sports before surgery, 9 (69.2%) returned to those sports. 17/38 (44.7%) patients participated in physical therapy after surgery. 35/38 (92.1%) of patients reported that the surgery improved their quality of life. Conclusion: The majority of patients who underwent surgery for chronic subdural hematoma were able to return to exercise within 1 year. Participation in physical therapy was associated with return to exercise and sports. Further study is needed to determine which factors contribute to a return to baseline levels of physical activity following surgery for chronic subdural hematoma.

scholarly journals Cerebrospinal fluid leak as a driving factor in chronic subdural hematoma formation: A histological study

2021 ◽  
Vol 12 ◽  
pp. 578
Author(s):  
Antonio Colamaria ◽  
Matteo Sacco ◽  
Savino Iodice ◽  
Nicola Pio Fochi ◽  
Francesco Carbone
Keyword(s):  
Cerebrospinal Fluid ◽  
Inflammatory Reaction ◽  
Subdural Hematoma ◽  
Histological Study ◽  
Fluid Collection ◽  
Traumatic Injury ◽  
Chronic Subdural Hematoma ◽  
Cerebrospinal Fluid Leak ◽  
Demographic Shift ◽  
Csf Leakage

Background: Chronic subdural hematoma (CSDH) represents the most common neurosurgical disease. Given the demographic shift toward an aging population, the overall incidence of this condition is increasing. Nevertheless, clarity in the pathophysiological process is yet to be made. Several etiological mechanisms have been proposed to initiate and consequently promote fluid collection in the subdural space. Traumatic injury of the bridging veins has long been considered the primum movens of the pathology but increasing evidence shows that trauma is not the only factor involved. Along with recent advances we sought to understand the role of the cerebrospinal fluid (CSF) in the buildup of the intense inflammatory reaction that characterizes CSDH. Methods: In the present study, we examined histological features of reactive membranes secondary to extracranial CSF leakage with CSDH-related membranes. Similarity and differences between the specimens were examined by means of light microscopy. Results: Histological similarities were consistently found between CSDH membranes and reactive membranes secondary to CSF leakage in the extracranial space. Activated histiocytes were highlighted in all specimens along with an intense inflammatory reaction. Conclusion: CSDH is most likely the result of a complex interaction among different pathophysiological events resulting from both traumatic and inflammatory etiologies. In the present work, we highlight how CSF leakage could be an early factor that leads to a cascade of events that culminates in CSDH formation.

Abstract WP429: Therapeutic Strategy For Chronic Subdural Hematoma Associated With Cerebrospinal Fluid Hypovolemia

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Takafumi Shimogawa
Keyword(s):  
Cerebrospinal Fluid ◽  
Subdural Hematoma ◽  
Therapeutic Strategy ◽  
Clinical Symptoms ◽  
Traumatic Injury ◽  
Chronic Subdural Hematoma ◽  
Treatment Result ◽  
Hematoma Evacuation ◽  
The Third ◽  
Blood Patch

Chronic subdural hematoma (CSH) with the cerebrospinal fluid (CSF) hypovolemia is often reported, but the therapeutic strategy is not established. We examined the therapeutic strategy and the treatment result for CSH with the CSF hypovolemia that we experienced in our hospital. [Object and method] In 544 patients with CSF hypovolemia during January 2000 to July 2012, 7 cases (1.3%) had CSH bilaterally. About CSF hypovolemia, 5 cases was diagnosed as spontaneous, 1 case as post-traumatic injury, and 1 case as post-traffic injury. We devided them into 3 groups; the first group which performed epidural blood patch (EBP) therapy first, the second group which performed hematoma evacuation for CSH first, and the third group group which performed the hematoma evacuation for CSH and EBP simultaneously. [Result] In the first group included 5 cases, only 1 case of CSH resolved spontaneously, and another 4 cases needed additional hematoma evacuation by aggravation of clinical symptoms. In the second group included 1 case, CSH recurred, and additional EBP therapy and hematoma evacuation were needed. In the third group included 1 case, the improvement of prompt clinical symptoms was obtained and CSH did not recurr. [Conclusion] The treatment for CSH with CSF hypovolemia needs EBP therapy first, however most cases needs an additional hematoma evacuation. If it takes into consideration, it may be better to do the hematoma evacuation and the EBP simultaneouly. In addition, it is necessary to consider a CSF hypovolemia as a cause of a bilateral CSH which relapse after treatment.

Sign in / Sign up

Export Citation Format

Share Document