Results of Stereotactic Aspiration in 175 Cases of Putaminal Hemorrhage

Abstract Believing that improved therapeutic results in cases of intracerebral hematoma might be obtained by minimal invasion of the brain, we used computed tomographic-guided stereotactic aspiration in 175 of 241 patients with putaminal hemorrhage. These patients, who were treated 6 or more hours after onset, had hematomas larger than 8 ml and were unable to raise an arm and/or leg on the affected side. Craniotomy was performed in 15 other patients, most of whom were brought to the hospital with large hematomas within 6 hours of onset. The remaining patients either had mild deficits of consciousness (33 patients) or severe deficits and/or were elderly (18 patients) and were treated conservatively. Thirteen patients (7.4%) showed rebleeding after stereotactic aspiration (6 instances of major and 7 instances of minor rebleeding). Craniotomy and removal of the hematoma were required in three of these patients. Aspiration should be avoided in patients who have a tendency for bleeding, even if mild, because rebleeding occurred in 6 of 23 such patients (26%) in these study. The consciousness level improved in 66 patients (38%), was unchanged in 103 patients (59%), and was worse in 6 patients (3%) 1 week postoperatively. Motor function of the arm improved in 55 patients (31%) and was worse in 23 patients (14%). Six months after surgery, the results for the 175 patients who underwent stereotactic aspiration were: 19% excellent, 32% good, 35% fair, 7% poor, 6% dead, and 1% unknown. For the entire series of 241 patients, the results were: 24% excellent, 26% good, 31% fair, 7% poor, 11% dead, and 1% unknown. These results seem to indicate that stereotactic aspiration can play a definite role in the treatment of spontaneous intracerebral hematoma.

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Head Trauma in Hemophilia: Value of Computer Tomography of The Brain in Localizing Multiple Hematomas

10.1055/s-0039-1682587 ◽

1977 ◽

Author(s):

D. Green ◽

P. Weinberg ◽

L. Cerullo ◽

D. McLone

Keyword(s):

Head Trauma ◽

Intracerebral Hematoma ◽

Computed Tomographic ◽

Cranial Trauma ◽

Post Operative Period ◽

Subdural Hematomas ◽

Neurological Defect ◽

Ct Brain ◽

Burr Holes ◽

The Brain

A 20 year old man with classical hemophilia (Factor VIII, 3%) was found unconscious in an alley after being struck on the head with a baseball bat. He transiently regained consciousness in the Emergency Room, but then became comatose and developed a right 3rd nerve palsy. He was immediately given AHF concentrate, 50 units per Kg, and had a computed tomographic (CT.) brain scan which revealed bilateral fronto-parietal subdural hematomas. These were removed through burr-holes and a right fronto-parieta1 craniotomy. He was maintained on 12-hourly doses of AHF concentrate, 50 u/per Kg, and did well for the first 3 post-operative days. Signs of increasing intracranial pressure then developed, and a repeat CT scan disclosed a right intracerebral hematoma. This was surgically evacuated and the remainder of his post-operative course was uneventful. He was discharged after 6 weeks of hospitalization with no residual neurological defect. A second patient, seen 6 years earlier for subdural hematomas following cranial trauma, also had evidence of deterioration in the early post-operative period. At that time, C.T. scans were not available, and the site of the new hematoma was not established. Although the patient recovered, there was a severe residual neurologic defect. Our experiences indicate that C.T. scans of the brain are valuable adjuncts in the management of head trauma in hemophilia, and, when combined with vigorous neurosurgical intervention, offer an improved prognosis.

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Postoperative Extradural Hematomas: Computed Tomographic Survey of 1105 Intracranial Operations

Neurosurgery ◽

10.1227/00006123-198610000-00013 ◽

1986 ◽

Vol 19 (4) ◽

pp. 589-593 ◽

Cited By ~ 50

Author(s):

Akira Fukamachi ◽

Hidehito Koizumi ◽

Yoshishige Nagaseki ◽

Hideaki Nukui

Keyword(s):

Brain Tumor ◽

Postoperative Period ◽

Ventricular Dilatation ◽

Systemic Hypertension ◽

Intracerebral Hematoma ◽

Causal Factors ◽

Computed Tomographic ◽

The Brain ◽

Shunting Procedure ◽

Ventricular Shunting

Abstract We reviewed the computed tomographic findings after 1055 intracranial operations to determine the incidence of postoperative extradural hematomas. There were 11 medium and 5 large hematomas after 1055 operations (1.0%). Ten of the 16 hematomas were operated upon (10/1055, 0.9%). Four of the 10 hematomas were seen after 278 brain tumor removals (1.4%), another four after 190 aneurysmal operations (2.1%), one after 14 intracerebral hematoma removals (7.1%), and the last one after 251 ventricular shunting or drainage procedures (0.4%). In 4 of the 10 operated hematomas, sites were regional, in five sites were adjacent, and in one the site was distant. All of the five adjacent hematomas extended downward from a lower rim of the operative locus. Causes were analyzed in the three types of the hematomas. In case of the regional hematomas, the causes were incomplete hemostasis of the dura mater or the bone in all four patients, nonperformance of central stay sutures in three, systemic hypertension in one, and hypofibrinogenemia in one. In the adjacent hematomas, we could find dural separation at an edge of craniotomy in all five patients, abrupt collapse of the brain in all, ventricular dilatation in two, and systemic hypertension during immediate postoperative period in two. In one distant hematoma, ventricular dilatation and ventricular shunting procedure were themselves thought to be the causal factors.

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Stereotactic Aspiration of Putaminal Hemorrhage Using a Double Track Aspiration Technique

Neurosurgery ◽

10.1227/00006123-198802000-00031 ◽

1988 ◽

Vol 22 (2) ◽

pp. 432-436 ◽

Cited By ~ 21

Author(s):

Hiroshi Niizuma ◽

Jiro Suzuki

Keyword(s):

Central Region ◽

Ct Scans ◽

Low Density ◽

Main Mass ◽

Stereotactic Aspiration ◽

Computed Tomographic ◽

Aspiration Technique ◽

Putaminal Hemorrhage ◽

Double Track ◽

Serum Components

Abstract Double track aspiration was used to remove the hematoma between 6 and 24 hours from onset in nine cases of putaminal hemorrhage. This technique was used in cases where an approach along the long axis of the hematoma was not feasible. With this method, aspiration is done at two target points lying anterior and posterior of the somewhat harder central region, at which aspiration is not attempted. This technique allows aspiration of most of the serum components, which are depicted as low density areas in computed tomographic (CT) scans, and some 53 to 85% of the main mass of the hematoma, which is seen on CT as high density areas. There was no rebleeding among these nine patients, and the remaining hematoma in all cases was located between two target points-a fact that is thought to indicate that the central portion of the hematoma is in fact somewhat harder than the peripheral portions. Although the double track aspiration technique has the disadvantage of producing two tracks, it is thought to be an effective method in such cases because it allows safe and thorough hematoma aspiration. (Neurosurgery 22:432-436, 1988)

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Stereotactic Aspiration of a Brain Stem Hematoma

Neurosurgery ◽

10.1227/00006123-198308000-00019 ◽

1983 ◽

Vol 13 (2) ◽

pp. 204-207 ◽

Cited By ~ 37

Author(s):

Robert M. Beatty ◽

Nicholas T. Zervas

Keyword(s):

Medical Student ◽

Brain Stem ◽

Ct Scanning ◽

Vascular Lesion ◽

Venous Angioma ◽

Stereotactic Aspiration ◽

Computed Tomographic

Abstract A medical student developed a progressive mesencephalic lesion found to be cystic in nature by computed tomographic (CT) scanning. Stereotactic aspiration of a pontomesencephalic hematoma was carried out twice, and the patient recovered. Angiography and CT scanning demonstrated a vascular lesion compatible with a venous angioma.

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Differential diagnosis of spontaneous intracranial hemorrhage in young

Medical Science And Education Of Ural ◽

10.36361/1814-8999-2021-22-1-83-86 ◽

2021 ◽

Vol 22 (1) ◽

pp. 83-86

Author(s):

O. A. Kicherova ◽

◽

L. I. Reikhert ◽

O. N. Bovt ◽

◽

...

Keyword(s):

Hemorrhagic Stroke ◽

Young Patients ◽

Vascular Diseases ◽

Cerebrovascular Diseases ◽

Intracerebral Hematoma ◽

Toxic Substances ◽

Brain Substance ◽

Secondary All ◽

Visualization Techniques ◽

The Brain

In recent years, cerebral vascular diseases have been increasingly detected in young patients. It is due not only to better physicians’ knowledge about this pathology, but also to the improvement of its diagnosis methods. Modern neuroimaging techniques allow us to clarify the nature of hemorrhage, to determine the volume and location of intracerebral hematoma, and to establish the degree of concomitant edema and dislocation of the brain. However, despite the high accuracy of the research, it is not always possible to establish the cause that led to a brain accident, which greatly affects the tactics of management and outcomes in this category of patients. A special feature of the structure of cerebrovascular diseases of young people is the high proportion of hemorrhagic stroke, the causes of which are most often arterio-venous malformations. Meanwhile, there are a number of other causes that can lead to hemorrhage into the brain substance. These include disorders of blood clotting, and various vasculitis, and exposure to toxic substances and drugs, and tumor formations (primary and secondary). All these pathological factors outline the range of diagnostic search in young patients who underwent hemorrhagic stroke. Diagnosis of these pathological conditions with the help of modern visualization techniques is considered to be easy, but this is not always the case. In this article, the authors give their own clinical observation of a hemorrhagic stroke in a young patient, which demonstrates the complexity of the diagnostic search in patients with this pathology.

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Simplified Stereotactic Aspiration of Intracerebral Hematoma Under Fluoroscopic Guidance

Surgery for Cerebral Stroke ◽

10.2335/scs1987.23.1_31 ◽

1995 ◽

Vol 23 (1) ◽

pp. 31-35

Author(s):

Masato NOJI ◽

Chia-Cheng CHANG ◽

Yasuhiro KOJIMA ◽

Nobumasa KUWANA

Keyword(s):

Intracerebral Hematoma ◽

Fluoroscopic Guidance ◽

Stereotactic Aspiration

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Transient Cortical Blindness after Coronary Angiography

Journal of International Medical Research ◽

10.1177/147323000903700433 ◽

2009 ◽

Vol 37 (4) ◽

pp. 1246-1251 ◽

Cited By ~ 9

Author(s):

BN Alp ◽

N Bozbuğa ◽

MA Tuncer ◽

C Yakut

Keyword(s):

Coronary Angiography ◽

Cerebral Haemorrhage ◽

Cortical Blindness ◽

Focal Neurological Deficit ◽

Computed Tomographic ◽

Contrast Enhanced ◽

Computed Tomographic Scan ◽

Transient Cortical Blindness ◽

Occipital Lobes ◽

The Brain

Transient cortical blindness is rarely encountered after angiography of native coronary arteries or bypass grafts. This paper reports a case of transient cortical blindness that occurred 72 h after coronary angiography in a 56-year old patient. This was the patient's fourth exposure to contrast medium. Neurological examination demonstrated cortical blindness and the absence of any focal neurological deficit. A non-contrast-enhanced computed tomographic scan of the brain revealed bilateral contrast enhancement in the occipital lobes and no evidence of cerebral haemorrhage, and magnetic resonance imaging of the brain showed no pathology. Sight returned spontaneously within 4 days and his vision gradually improved. A search of the current literature for reported cases of transient cortical blindness suggested that this is a rarely encountered complication of coronary angiography.

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Focal Ischemic Cerebral Injury in the Newborn: Diagnosis by Ultrasound and Correlation with Computed Tomographic Scan

PEDIATRICS ◽

10.1542/peds.71.5.790 ◽

1983 ◽

Vol 71 (5) ◽

pp. 790-793

Author(s):

Alan Hill ◽

David J. Martin ◽

Alan Daneman ◽

Charles R. Fitz

Keyword(s):

Term Infant ◽

Cerebral Injury ◽

Ultrasound Scanning ◽

Older Children ◽

Cerebral Lesions ◽

Ischemic Brain ◽

Computed Tomographic ◽

Cerebral Ischemic ◽

The Brain

Ischemic brain injury in the newborn is a common cause of subsequent neurologic deficits seen in older children. Clearly, determination of severity and location of such injury is important for management and prognosis. Although ultrasound scanning of the brain has been used extensively in the premature infant for diagnosis of hemorrhagic lesions, its use in the term infant for recognition of isehemic cerebral lesions has not been reported. Four cases are described in which focal echodense areas were identified on ultrasound scan of the brain. These echodense areas on ultrasound corresponded to the appearance on computed tomographic (CT) scan of areas of decreased density which are known to represent ischemic cerebral injury. In three of the four cases there were focal neurologic findings and/or focal abnormalities on EEG. In two cases, real-time ultrasound scanning demonstrated changes in arterial pulsations in cerebral vessels in the area of the lesions. Thus in both, there was diminution in pulsations within the echodense areas and in one case, an increase in pulsations was observed at the periphery of the echodense lesion. Our data demonstrate the value of ultrasound scanning for assessment of the extent and location of focal cerebral ischemic lesions in the newborn. Such assessment permite assessment of prognosis.

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NeuroPort: Retractor tubular personalizado para cirugías mínimamente invasivas fabricado mediante impresión 3D por estereolitografía

10.24254/cnib.21.52 ◽

2021 ◽

Author(s):

◽

C. J. González Leal

Keyword(s):

High Resolution ◽

3D Printing ◽

Brain Tumors ◽

Vascular Malformations ◽

Low Cost ◽

Lighting System ◽

Minimal Invasion ◽

The Brain ◽

Intended Use ◽

Printing Method

NeuroPort is a low cost customized biodevice for minimal invasion surgeries designed within Servicio Neurocirugía UANL and Departamento de Ingeniería Biomédica; and manufactured by stereolithography, a high- resolution 3D printing method. This biodevice provides a channel of approach for subcortical and intraventricular cerebral surgical procedures with an intended use in the treatment of diseases such as brain tumors, anomalies or vascular malformations, parenchymal hematomas, among others. It has a design that minimizes tissue damage by displacing the tissues of the brain during the advance toward the desired abnormality; in addition to its integration with neuronavigational equipment and its own lighting system. All these features designed to make the surgical procedure faster and safer for the patient, facilitating the work of the neurosurgeon.

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