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World Neurosurgery Apr 2020The use of drains has been considered to be superior to no drains after burr hole drainage of chronic subdural hematomas (CSDHs). Therefore, routine placement of a... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
The use of drains has been considered to be superior to no drains after burr hole drainage of chronic subdural hematomas (CSDHs). Therefore, routine placement of a subdural drain (SDD) is supported by most neurosurgeons. However, whether the drain location after CSDH burr hole evacuation influences patient outcomes is unclear. Therefore, we compared the efficacy and safety of subperiosteal drains (SPDs) with those of SDDs for patients with CSDHs.
METHODS
Using the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, eligible studies reported up to September 2019 were identified through a search of MEDLINE, EMBASE, and Cochrane Central. Pooled estimates, confidence intervals (CIs), and odds ratios (ORs) were calculated for all outcomes.
RESULTS
Ten studies with 3169 patients were included. The use of a SPD after CSDH burr hole drainage resulted in a significant decrease in recurrences compared with the use of a SDD (OR, 0.73; 95% CI, 0.58-0.92; I, 14%; P = 0.007). No significant differences were identified between the SPD and SDD groups in the favorable outcomes (OR, 1.29; 95% CI, 1-1.68; I, 0%; P = 0.05). Adverse event rates, including mortality, seizures, and surgical infection, were not significantly different between the 2 groups. However, the use of SPDs was associated with a lower risk of parenchymal injuries compared with SDDs (OR, 0.29; 95% CI, 0.11-0.76; I, 0%; P = 0.01).
CONCLUSIONS
The results from the present meta-analysis suggest that the use of an SPD is safer and might be more effective than an SDD in the treatment of CSDH. However, more large randomized controlled trials are needed to investigate the use of SPDs in the management of CSDH.
Topics: Drainage; Hematoma, Subdural, Chronic; Humans; Neurosurgical Procedures; Periosteum; Postoperative Complications; Recurrence; Reoperation; Seizures; Subdural Space; Surgical Wound Infection; Treatment Outcome
PubMed: 31927124
DOI: 10.1016/j.wneu.2019.12.180 -
World Neurosurgery Jul 2020Transdural disc herniations represent about 0.3% of all herniated discs. Preoperative imaging rarely demonstrates this condition. Therefore, diagnosis of transdural disc...
BACKGROUND
Transdural disc herniations represent about 0.3% of all herniated discs. Preoperative imaging rarely demonstrates this condition. Therefore, diagnosis of transdural disc herniation is usually made intraoperatively. We describe the clinicopathologic features of extremely rare cases of thoracic and lumbar interdural disc herniations mimicking spinal intradural en plaque tumors.
METHODS
This is a retrospective case series with a systematic literature review. Clinical presentation, imaging, differential diagnosis, intraoperative microsurgical findings, and possible pathogenesis were reviewed according to published guidelines. All patients underwent a posterior approach for microsurgical excision of disc herniation, but no epidural lesion was found. At intradural exploration, a tumor-like en plaque lesion was discovered. The surface of the lesion was incised, and multiple friable, cartilaginous white-yellow fragments were removed to achieve complete intralesional excision.
RESULTS
The postoperative course was characterized by progressive neurologic improvement in all cases. In peculiar anatomic (adhesions between the anulus fibrosus, posterior longitudinal ligament, and ventral surface of dura mater) and pathologic (calcified giant disc herniation, spinal canal stenosis, previous lumbar spine surgery) conditions, penetration of disc fragment in the thickness of spinal dura mater can occur.
CONCLUSIONS
Interdural disc herniations constitute a rare pathologic condition characterized by the migration of the herniated disc in neither the epidural nor the subdural spinal space, but rather in the thickness of the spinal dura mater. Further advances are necessary in neuroradiologic investigations to achieve a correct preoperative diagnosis, which is essential, as spine surgeons must be aware of these rare pathologies.
Topics: Aged; Calcinosis; Dura Mater; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Microsurgery; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 32305597
DOI: 10.1016/j.wneu.2020.04.015 -
Journal of Neuro-oncology Oct 2010Bone involvement is a common finding in many types of lymphoma (Clin Oncol 9(3): 195-196, 1997). However, cranial vault affliction has been regarded as an exceedingly... (Review)
Review
Bone involvement is a common finding in many types of lymphoma (Clin Oncol 9(3): 195-196, 1997). However, cranial vault affliction has been regarded as an exceedingly rare presentation, particularly in the case of primary lymphoma (J Neurosurg 108(5): 1018-1020, 2008). Our objective is to describe a series of five immunocompetent patients with histologically confirmed cranial vault lymphoma (CVL), and to conduct a systematic review of the current literature. Our review points out identical imaging patterns in most of the lesions for all reported CVL cases, despite their different histological subtypes. This typical pattern can be seen on computed tomography (CT) scans and magnetic resonance imaging (MRI) as an expansive tumor that affects all three compartments of the cranial vault, including the scalp, skull bone, and pachymeninges, even in the absence of osteolysis. We argue that the absence of osteolysis might enhance diagnostic capability. In the appropriate clinical setting, these features represent important disease characteristics that may help with an earlier diagnosis. Large B-cell lymphoma was the most common subtype of primary CVL.
Topics: Adolescent; Adult; Aged; Dura Mater; Female; Humans; Immunocompetence; Lymphoma; Magnetic Resonance Imaging; Male; Middle Aged; PubMed; Scalp; Skull; Tomography, X-Ray Computed
PubMed: 20146083
DOI: 10.1007/s11060-010-0137-5