Multiple tenting techniques improve dead space obliteration in the surgical treatment for patients with giant calcified chronic subdural hematoma
| Autor: | E-Jian Lee, Shih-Huang Tai, Wei-Sheng Juan, Yu-Chang Hung |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty Radiography Dead space Neurosurgical Procedures Hematoma Chronic subdural hematoma medicine Humans Child Neuroradiology medicine.diagnostic_test business.industry Calcinosis Interventional radiology medicine.disease Surgery Hematoma Subdural Chronic Female Neurology (clinical) Neurosurgery business Rare disease |
| Zdroj: | Acta Neurochirurgica. 154:707-710 |
| ISSN: | 0942-0940 0001-6268 |
| DOI: | 10.1007/s00701-011-1234-8 |
| Popis: | Calcified chronic subdural hematoma (CCSDH), or "armored brain," is a rare disease entity. The optimal surgical procedure for CCSDH has not been established because it is hard to obtain brain re-expansion after surgery. In particular, a large CCSDH is difficult to completely extirpate, and the residual rigid inner and outer membranes facilitates dead space retention and hematoma recurrence.We introduce the use a multiple suturing technique to tent the residual outer and inner membranes onto the dura matter so as to obliterate dead space after surgical treatment for CCSDH. Neuroimaging and surgical reports with illustrative images from two cases are shown.Two patients were admitted to our intensive care unit more than 10 years apart from their ventriculoperitoneal (V-P) shunt placements. The first patient presented with clinical signs of increased intracranial pressure. The second patient had a large CCSDH as a concomitant finding with ruptured aneurysmal subarachnoid hemorrhage. Computerized cranial tomography demonstrated large hematoma cavities with thick calcified inner membranes. After neurosurgical intervention by craniotomy and optimal resection of calcified membranes and muddy blood clot, we tented the residual calcified inner and outer membranes onto the dura matter by multiple sutures to reduce dead space accumulation. Postoperatively, the two patients had improved clinical symptoms along with much reduced hematoma cavity in imaging examinations.We reported an alternative technique using multiple tenting procedures to improve dead space obliteration after surgical treatment for patients with a large CCSDH presenting as a late complication after V-P shunting. |
| Databáze: | OpenAIRE |
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