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Epidural hematoma typically manifests following craniocerebral trauma, stemming from injury to the meningeal artery or venous system, predominantly on one side. Instances of spontaneous epidural hematoma are uncommon, with occurrences of spontaneous bilateral epidural hematoma being exceedingly rare. Sickle cell disease, adjacent paranasal sinusitis, and tumor metastases are the most prevalent causes of spontaneous epidural hematoma. This case study presents an individual with abdominal liposarcoma exhibiting reduced coagulation factor XII activity, who experienced sudden unconsciousness due to spontaneous acute bilateral epidural hematoma, and subsequently achieved a favorable outcome following surgical intervention. [ABSTRACT FROM AUTHOR]

Intracranial hematoma, a severe brain injury caused by trauma or cerebrovascular disease, can result in blood accumulation and compression of brain tissue. Untreated cases can cause headaches, impaired consciousness, and even brain tissue damage or death. Therefore, early and accurate diagnosis is crucial. Traditional segmentation methods require physicians with extensive clinical experience and expertise to manually mark out the hematoma region, but for hematoma cases with irregular shapes and uneven grey levels, this process is cumbersome, and the segmentation results are not good. Existing deep learning‐based methods are more likely to perform binary segmentation, considering all hematomas as a class and segmenting them, but this segmentation cannot capture more detailed information and lacks the analysis of different types of hematomas. To address these problems, an ICH segmentation network combining CNN and Transformer Encoder is proposed for accurate segmentation of different types of hematomas. The network incorporated edge information and long‐range context into the segmentation process. Experimental results using the CQ500 dataset demonstrate comparable performance to existing methods, with mIoU (0.8705), TPR (0.9273), mAP (0.9300), and DSC (0.9286) as the best metrics achieved by this paper's method. [ABSTRACT FROM AUTHOR]

Epidural hematoma typically manifests following craniocerebral trauma, stemming from injury to the meningeal artery or venous system, predominantly on one side. Instances of spontaneous epidural hematoma are uncommon, with occurrences of spontaneous bilateral epidural hematoma being exceedingly rare. Sickle cell disease, adjacent paranasal sinusitis, and tumor metastases are the most prevalent causes of spontaneous epidural hematoma. This case study presents an individual with abdominal liposarcoma exhibiting reduced coagulation factor XII activity, who experienced sudden unconsciousness due to spontaneous acute bilateral epidural hematoma, and subsequently achieved a favorable outcome following surgical intervention. [ABSTRACT FROM AUTHOR]

Background: Although subdural hematoma is a rare complication after spinal anesthesia, there have been no reports of an intracranial epidural hematoma after cesarean section with spinal anesthesia. Case presentation: A 32-year-old nulliparous woman at the 35th week of a twin pregnancy underwent an emergency cesarean section due to her first contraction. She had no preoperative complications and the spinal anesthesia was uneventful, with 0.5% bupivacaine 12 mg and fentanyl 15 µg from the L3/4 intervertebral space. She complained of headache and nausea 15 min after spinal anesthesia, demonstrating a consciousness disturbance after surgery. Computed tomography 2 h after the cesarean section revealed an intracranial epidural hematoma. She underwent decompressive craniotomy 1 h later. Conclusion: This case highlights the possible development of an intracranial epidural hematoma in low-risk obstetric patients. [ABSTRACT FROM AUTHOR]

Background: Intra cranial hematoma (ICH) can be a life-threatening condition in many cases. The outcome depends on various factors, one such being spontaneous ICH expansion. Timely identification of ICH expansion can help us prognosticate the patient and provide individualized care. The present study aimed to determine the incidence of ICH expansion and determine the clinical and radiological variables predicting expansion; along with the prognosis of these patients. Materials and Methods: This prospective and observational study included 94 ICH patients, who presented within 24 h of symptom onset. ICH volume was measured using ABC/2 method, and repeat computed tomography was done within 72 h or when clinically indicated. Clinical and radiological parameters were noted and looked for the prognosis of patient after expansion in the form of average hospital stay, ICH score, and modified Rankin Scale (mRS). Results: Out of 94 patients, 14 (15%) patients showed expansion (10 males [71%], 4 females [29%]). In clinical profile, headache (P = 0.04) and hemiparesis (P < 0.001), and radiologically marginal irregularity (P < 0.001), hypodensities (P < 0.001), ovoid shape (P = 0.004), and circular shape (P = 0.04) showed significant results. While initial volume (P = 0.16), systolic blood pressure (P = 0.28), fluid level (P = 0.15), cerebral edema (P = 0.18), and Intra ventricular extension (IV) (P = 0.98) were more in expander group but did not reach to statistically significant level. Prognosis worsened with prolonged stay (P = 0.05) and deterioration of ICH score (P = 0.02) as well as mRS. Conclusions: Certain clinical (early presentation and hemiparesis) and radiological (hypodensity within hematoma, marginal irregularity, and ellipsoid shapes) parameters are significantly associated with hematoma expansion. Insight into these predictors can improve the prognosis of hematoma expansion in patients with spontaneous ICH. [ABSTRACT FROM AUTHOR]

Background: Intra cranial hematoma (ICH) can be a life-threatening condition in many cases. The outcome depends on various factors, one such being spontaneous ICH expansion. Timely identification of ICH expansion can help us prognosticate the patient and provide individualized care. The present study aimed to determine the incidence of ICH expansion and determine the clinical and radiological variables predicting expansion; along with the prognosis of these patients. Materials and Methods: This prospective and observational study included 94 ICH patients, who presented within 24 h of symptom onset. ICH volume was measured using ABC/2 method, and repeat computed tomography was done within 72 h or when clinically indicated. Clinical and radiological parameters were noted and looked for the prognosis of patient after expansion in the form of average hospital stay, ICH score, and modified Rankin Scale (mRS). Results: Out of 94 patients, 14 (15%) patients showed expansion (10 males [71%], 4 females [29%]). In clinical profile, headache (P = 0.04) and hemiparesis (P < 0.001), and radiologically marginal irregularity (P < 0.001), hypodensities (P < 0.001), ovoid shape (P = 0.004), and circular shape (P = 0.04) showed significant results. While initial volume (P = 0.16), systolic blood pressure (P = 0.28), fluid level (P = 0.15), cerebral edema (P = 0.18), and Intra ventricular extension (IV) (P = 0.98) were more in expander group but did not reach to statistically significant level. Prognosis worsened with prolonged stay (P = 0.05) and deterioration of ICH score (P = 0.02) as well as mRS. Conclusions: Certain clinical (early presentation and hemiparesis) and radiological (hypodensity within hematoma, marginal irregularity, and ellipsoid shapes) parameters are significantly associated with hematoma expansion. Insight into these predictors can improve the prognosis of hematoma expansion in patients with spontaneous ICH.

Purpose: Post-traumatic cerebral venous sinus thrombosis (ptCVT) is a rare but serious complication of traumatic brain injury (TBI). Managing ptCVT is challenging due to the concurrent risk of traumatic intracranial hematoma (ICH) expansion. Limited data exists on the safety and efficacy of anticoagulation therapy (ACT) in these cases. Methods: This single-center observational cohort study included adult TBI patients with concurrent ICH and ptCVT. Low-molecular-weight heparin (LMWH) or heparin infusion was used to treat all ptCVTs based on institutional protocols. The outcomes of interest were hemorrhagic and thrombotic complications. Results: Out of 1,039 TBI-patients admitted between 2006 and 2020, 32 met the inclusion criteria. The median time from injury to ptCVT diagnosis was 24 h. ACT was initiated at a median of 9 h after ptCVT diagnosis. Patients were administered either heparin infusion (n = 8) or LMWH at dosages ranging from 28 to 72% of the therapeutic level (n = 24). There were no hemorrhagic complications, even in patients receiving LMWH at ≥ 50% of the therapeutic dose. Thrombotic complications occurred in 3 patients (9.4%) – two cases of thrombus progression and one venous infarct. The patients who developed thrombotic complications differed from those who did not by having a 17-h delay in ACT initiation after diagnosis or by receiving an initial LMWH dose at 28% of the therapeutic level. Conclusion: LMWH at approximately 50% of the therapeutic level was effective for managing ptCVT associated with TBI in our retrospective dataset, with no risk of hematoma expansion. Prospective trials are warranted to confirm these results. [ABSTRACT FROM AUTHOR]

Intracranial hemorrhage (ICH) causes numerous neurological deficits and deaths worldwide each year, leaving a significant health burden on the public. The pathophysiology of ICH is complicated and involves both primary and secondary injuries. Hematoma, as the primary pathology of ICH, undergoes metabolism and triggers biochemical and biomechanical alterations in the brain, leading to the secondary injury. Past endeavors mainly aimed at biochemical-initiated mechanisms for causing secondary injury, which have made limited progress in recent years, although ICH itself is also highly biomechanics-related. The discovery of the mechanically-activated cation channel Piezo1 provides a new avenue to further explore the mechanisms underlying the secondary injury. The current article reviews the structure and gating mechanisms of Piezo1, its roles in the physiology/pathophysiology of neurons, astrocytes, microglia, and bone-marrow-derived macrophages, and especially its roles in erythrocytic turnover and iron metabolism, revealing a potential interplay between the biomechanics and biochemistry of hematoma in ICH. Collectively, these advances provide deeper insights into the secondary injury of ICH and lay the foundations for future research. [ABSTRACT FROM AUTHOR]

Background: The outcomes in traumatic intracranial hematoma (TICH) have not improved significantly despite advances in trauma care. A modifiable factor in TICH management is time to operation room (TOR). TOR has become a key marker in Traumatic brain injury care despite a lack of contemporary evidence. This study aimed to determine the timing of TICH evacuation and its association with mortality and neurological outcomes. Methods: A systematic review of PubMed, OVID MEDLINE, CINAHL, and Web of Science. Included studies reported data on adult patients with acute TICH who underwent surgical evacuation. The primary outcome was TOR and its association with mortality or functional neurological recovery. Results: From 1838 articles screened, 17 were included. Eight studies reported TOR as a continuous variable, ranging between 3 and 7.1 h. Three studies found better outcomes with shorter TOR, five found no difference, and one found worse outcomes with shorter TOR. Five articles were included in meta‐analysis of mortality in patients undergoing operative decompression less than or greater than 4 h from injury which found lower mortality in the >4‐h group, OR = 1.53. Longitudinal regression analysis showed no difference in TOR over the 33‐year span of articles included. Conclusion: There is limited data available on TOR in TICH, with equivocal results on the effect of timing on outcomes. TOR has not decreased over the last 4 decades. The unvalidated 4‐h cut‐off seems to be associated with better survival. Contemporary assessment of this potentially important performance indicator is required. [ABSTRACT FROM AUTHOR]

By maximizing the advantages of exoscopy, we developed a keyhole approach for intracranial hematoma removal. Herein, we validated the utility of this procedure, and compared it with conventional microscopic hematoma removal and endoscopic hematoma removal in our institution. We included 12 consecutive patients who underwent this procedure from June 2022 to March 2024. A 4-cm-long skin incision was made, and a keyhole craniotomy (diameter, 2.5 cm) was performed. An assistant manipulated a spatula, and an operator performed hematoma removal and hemostasis using typical microsurgical techniques under an exoscope. The dura mater was reconstructed without sutures using collagen matrix and fibrin glue. The outcomes of this series were compared with those of 12 consecutive endoscopic hematoma removals and 19 consecutive conventional microscopic hematoma removals from October 2018 to March 2024. The mean age was 72 ± 10 years, and 7 (58%) patients were men. Hematoma location was the putamen in 5 patients and subcortical in 7 patients. The mean operative time was 122 ± 34 min, the mean hematoma removal rate was 95% ± 8%, and the mortality rate was 0%. Although the preoperative hematoma volume was similar between the 3 groups, the operative time and total time in the operating room was significantly shorter in the exoscope group than in the microscope group (P < 0.0001). This procedure may be simpler and faster than conventional microscopic hematoma removal, and comparable to endoscopic hematoma removal. [ABSTRACT FROM AUTHOR]

Background and objectives: This study aimed to assess the impact and predicted outcomes of patients with multiple trauma by identifying the prevalence of trauma sustained and associated complications. Materials and Methods: This retrospective cohort study focused on individual characteristics of patients with multiple trauma admitted to our County Emergency Hospital. The final table centralized the characteristics of 352 subjects aged between 3 and 93 years who presented with multiple trauma from 2015 to 2021. Inclusion criteria for this study were the presence of multiple trauma, intervention times, mentioned subjects' ages, and types of multiple trauma. Results: Patients with multiple trauma face an increased risk of mortality due to the underlying pathophysiological response. Factors that can influence the outcomes of multiple-trauma patients include the severity of the initial injury, the number of injuries sustained, and the location of injuries. Conclusion: The first 60 min after trauma, known as the "golden hour," is crucial in determining patient outcomes. Injuries to the head, neck, and spine are particularly serious and can result in life-threatening complications. [ABSTRACT FROM AUTHOR]

Spontaneous intracranial hypotension (SIH) is a potentially debilitating condition resulting from a low cerebrospinal fluid (CSF) volume secondary to spinal CSF leakage. Characteristic clinical and radiological imaging findings are helpful in diagnosis. Herein, we present and discuss the magnetic resonance imaging (MRI) and CSF flow study of two patients with SIH and no CSF flow within the cerebral aqueduct, which is extremely rare in the literature. [ABSTRACT FROM AUTHOR]

Spontaneous intracranial hemorrhage (ICH) patients are still at risk of postoperative ischemic complications (PICs) after surgery. In addition, the proportion of patients receiving antiplatelet therapy (APT) in ICH patients increased significantly with age. This study aims to evaluate the impact of preoperative antiplatelet therapy on PICs in ICH patients. This is a cohort study that retrospectively analyzed the data of ICH patients who underwent surgical treatment. PICs rate was compared between patients with preoperative ATP and those without preoperative ATP. Univariate and multivariate analyses were conducted to evaluate the impact of preoperative APT on PICs. In addition, Kaplan-Meier method was used for survival analysis and the impact of PICs on patients' postoperative outcomes was evaluated. A total of 216 patients were included in this study. There were 47 patients (21.76%) with preoperative APT; 169 patients (78.24%) without preoperative APT. The incidence of PICs in the APT group was significantly higher when compared with that in the nAPT group (36.17% vs. 20.71%, p = 0.028＜0.05). Furthermore, significant differences were both observed in multivariate analysis (p = 0.035＜0.05) and survival analysis (log rank χ2 = 5.415, p = 0.020＜0.05). However, there was no significant difference between the outcomes of patients suffering from PICs and that of patients not suffering from PICs (p = 0.377 > 0.05). In conclusion, preoperative APT may be a risk factor for PICs in ICH patients undergoing surgical treatment significantly. [ABSTRACT FROM AUTHOR]

Traumatic intracranial aneurysm (TICA) is a rare and aggressive pathology that requires prompt treatment. Nevertheless, early vascular imaging following head trauma may yield falsely negative results, underscoring the importance of subsequent imaging within the first week to detect delayed TICAs. This study aims to report our experience with delayed TICAs and highlight the clinical importance of repeated angiographic screening for delayed TICAs. In this retrospective analysis, we evaluated patients managed for a TICA at a tertiary care teaching institution over the last decade. Additionally, we conducted a systematic review of the literature, following the PRISMA guidelines, on previously reported TICAs, focusing on the time lag between the injury and diagnosis. Twelve delayed TICAs were diagnosed in 9 patients. The median time interval from injury to diagnosis was 2 days (IQR: 1–22 days), and from diagnosis to treatment was 2 days (IQR: 0–9 days). The average duration of radiological follow-up was 28 ± 38 months. At the final follow-up, four patients exhibited favorable neurological outcomes, while the remainder had adverse outcomes. The mortality rate was 22%. Literature reviews identified 112 patients with 114 TICAs, showcasing a median diagnostic delay post-injury of 15 days (IQR: 6–44 days), with 73% diagnosed beyond the first week post-injury. The median time until aneurysm rupture was 9 days (IQR: 3–24 days). Our findings demonstrate acceptable outcomes following TICA treatment and highlight the vital role of repeated vascular imaging after an initial negative computed tomography or digital subtraction angiography in excluding delayed TICAs. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to highlight presentations, acute findings and imaging phenotypes of patients presenting to the emergency department (ED) within 30 days of a transcatheter aortic valve replacement (TAVR). Methods: A retrospective review of patients diagnosed with aortic valve disease who underwent a TAVR between Jan 2015 and Nov 2021 at a large academic medical center was completed. From an initial 1271 patients, 146 were included based on their presentation to the ED within 30 days post-TAVR procedure. Patient data, including ED presentation details and imaging results, were recorded and de-identified. Results: Of the 146 post-TAVR patients, there were 168 ED visits within 30 days. The median time to ED after TAVR was 12 days. Respiratory symptoms were the most common complaint (27%). Neurological (23%) and cardiovascular symptoms (18%) followed. Cross-sectional imaging was conducted 250 times across visits, with an average of 1.7 scans per patient. CTs were most frequently used, followed by ultrasounds, especially echocardiograms and duplex extremity vasculature ultrasounds. 30.1% of patients had acute findings from imaging. Specific findings included heart failure (5.5%), access site complications (5.5%), pneumonia (5.5%), intracranial pathologies (3.4% for strokes and 0.7% for hematoma), and pleural effusion (3.4%). Echocardiograms and CTA chest were most associated with significant acute findings. Conclusion: Our study highlights the vital role of early and accurate imaging in post-TAVR patients within 30 days post-procedure. As transcatheter approaches rise in popularity, emergency radiologists become instrumental in diagnosing common post-procedural presentations. Continued research is essential to devise post-discharge strategies to curtail readmissions and related costs. Proper imaging ensures prompt, effective care, enhancing overall patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Hypertensive intracerebral hemorrhage is one of the most serious complications of hypertension. The treatment focuses on reducing bleeding damage and promoting functional recovery. Aim: This study investigated the efficacy and prognosis of endoscopic intracranial hematoma removal (EIHR) and hematoma puncture and drainage (HPD) in treating hypertensive intracerebral hemorrhage (HICH). Material and methods: Ninety-two patients admitted to our hospital for EIHR and HPD between September 30, 2021 and September 30, 2022 were enrolled, including 14 cases of EIHR (endoscopy group) and 78 cases of HPD (puncture group). The efficacy of the two surgery modes in treating HICH patients was compared. Univariate logistic regression (ULR) and multivariate logistic regression (MLR) were employed to analyze the influences of different treatment methods on the prognosis of patients with HICH. Results: The average hematoma clearance rate (HCR) of all patients was 80.52%, and the patients in the endoscopy group had a higher HCR than those in the puncture group (73.00% vs. 86.00%) (p < 0.001). The good prognosis rate (GPR) shown by the Glasgow Outcome Scale (GOS) score in the endoscopy group was 69.23%, and that in the puncture group was 40.38%, a large but statistically non-significant difference (p > 0.05). Conclusions: The HCR of EIHR was greatly higher based on that of HPD, but showed no great difference in prognostic effect. The higher the GCS score on admission, the lower the likelihood of poor prognosis. [ABSTRACT FROM AUTHOR]

Intracranial hemorrhage (ICH) is a severe condition that requires rapid diagnosis and treatment. Automated methods for calculating ICH volumes can reduce human error and improve clinical decisioPlease provide professional degrees (e.g., PhD, MD) for the corresponding author.n-making. A novel automated method has been developed that is comparable to the ABC/2 method in terms of speed and accuracy while providing more accurate volumetric data. We developed a novel automated algorithm for calculating intracranial blood volume from computed tomography (CT) scans. The algorithm consists of a Python script that processes Digital Imaging and Communications in Medicine images and determines the blood volume and ratio. The algorithm was validated against manual calculations performed by neurosurgeons. Our novel automated algorithm for calculating intracranial blood volume from CT scans demonstrated excellent agreement with the ABC/2 method, with a median overall difference of just 1.46 mL. The algorithm was also validated in patient groups with ICH, epidural hematoma (EDH), and SDH, with agreement coefficients of 0.992, 0.983, and 0.997, respectively. The study introduces a novel automated algorithm for calculating the volumes of various ICHs (EDH, and SDH) within CT scans. The algorithm showed excellent agreement with manual calculations and outperformed the commonly used ABC/2 method, which tends to overestimate ICH volume. The automated algorithm offers a more accurate, efficient, and time-saving approach to quantifying ICH, EDH, and SDH volumes, making it a valuable tool for clinical evaluation and decision-making. [Display omitted] [ABSTRACT FROM AUTHOR]

Spontaneous intracranial hypotension (SIH) is an important cause of daily headaches that occur in young and middle-aged, active persons and is often misdiagnosed, leading to prolonged inactivity and rather high healthcare expenditures. Its diagnosis requires a high degree of clinical suspicion and careful interpretation of imaging studies. We present a case of SIH, which was successfully treated but which posed serious diagnostic challenges, ranging from cerebro-vascular disease and meningitis to granulomatous diseases, and for whom every therapeutic attempt just worsened the patient's condition until we finally reached the correct diagnosis. To raise awareness of this condition, we also present an updated overview of the clinical picture, evaluation, and treatment options for SIH. [ABSTRACT FROM AUTHOR]

Introduction: One of the most serious complications associated with antiplatelet agents is antiplatelet‐associated intracranial hemorrhage (AA‐ICH). Desmopressin is a synthetic antidiuretic hormone (ADH) analog. It has been linked to improving patient outcomes in antiplatelet‐induced intracranial hemorrhage. The secondary outcomes included the incidence of thrombotic complications and neurological outcomes. Methods: A systematic search was conducted on three databases (PubMed, Cochrane, and ClinicalTrials.gov) to find eligible literature that compares desmopressin (DDAVP) versus controls in patients with AA‐ICH. The Mantel–Haenszel statistic was used to determine an overall effect estimate for each outcome by calculating the risk ratios and 95% confidence intervals (CI). Heterogeneity was measured using the I2 test. The risk of bias in studies was calculated using the New Castle Ottowa Scale. Results: Five studies were included in the analysis with a total of 598 patients. DDAVP was associated with a nonsignificant decrease in the risk of hematoma expansion (RR =.8, 95% CI,.51–1.24; p =.31, I2 = 44%). It was also associated with a non‐significant decrease in the risk of thrombotic events (RR,.83; 95% CI,.25–2.76; p =.76, I2 = 30%). However, patients in the DDAVP group demonstrated a significant increase in the risk of poor neurological outcomes (RR, 1.31; 95% CI, 1.07–1.61; p =.01, I2 = 0%). The risk of bias assessment showed a moderate to low level of risk. Conclusion: DDAVP was associated with a nonsignificant decrease in hematoma expansion and thrombotic events. However, it was also associated with a significantly poor neurological outcome in the patients. Thus, until more robust clinical trials are conducted, the use of DDAVP should be considered on a case‐to‐case basis. [ABSTRACT FROM AUTHOR]

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Objective:To systematically evaluate the efficacy and safety of minimally invasive removal of intracranial hematoma combined with Naoxueshu treatment for spontaneous cerebral hemorrhage. Methods:Computer search was conducted on Chinese and English databases including CNKI, VIP, Wanfang, CBM, PubMed, Embase and the Cochrane Library from the establishment of the database to June 2023, based on inclusion and exclusion criteria to select randomized controlled trials (RCTS) of minimally invasive removal of intracranial hematoma combined with Naoxueshu oral liquid in the treatment of spontaneous intracerebral hemorrhage. The risk of bias was evaluated according to the Cochrane Systematic Review Manual, and meta-analysis was performed using Revman5.4 software, and the GRADE system was used to evaluate the evidence quality of outcome indicators. Results:Totally 9 RCTs were included, and the total sample size was 739 cases. There were 371 cases in the control group and 368 cases in the experimental group. The results of meta-analysis showed that compared with only conventional Western medicine after minimally invasive surgery, combined application of Naoxueshu oral liquid improved the overall clinical effectiveness rate [OR=5.47, 95%CI=2.28, 13.09, P=0.000 1], obviously reduced the score of National Institute of Health Stroke Scale [MD=-3.42, 95%CI=-4.97, -1.87, P<0.000 1], and neurological impairment score Chinese stroke patients [MD=-2.30, 95%CI=-3.01, -1.58, P<0.000 01], improved Glasgow Coma Scale score [MD=1.51, 95%CI=1.13, 1.89, P<0.000 01] and Barthel Index (BI) score [MD=6.88, 95%CI=4.49, 9.27, P<0.000 01], and decreased serum S100 protein [MD=-0.02, 95%CI=-0.03, -0.02, P<0.000 01] and AQP4 levels [MD=-0.02, 95%CI=-0.03, -0.01, P=0.002[. In terms of safety, no serious adverse reactions were reported;gastrointestinal discomfort symptoms including nausea, abdominal distension and diarrhea were reported in 2 studies; no adverse reactions were reported in the remaining studies. Conclusion:Existing evidence shows that minimally invasive removal of intracranial hematoma combined with Naoxueshu oral liquid in the treatment of spontaneous cerebral hemorrhage has obvious effects in reducing the degree of neurological impairment and consciousness disorder, improving patients' daily living ability, ameliorating patients' quality of life and other aspects, and has certain safety. [ABSTRACT FROM AUTHOR]

We aim to develop machine learning (ML) models for predicting the complexity and mortality of polytrauma patients using clinical features, including physician diagnoses and physiological data. We conducted a retrospective analysis of a cohort comprising 756 polytrauma patients admitted to the intensive care unit (ICU) at Pizhou People's Hospital Trauma Center, Jiangsu, China between 2020 and 2022. Clinical parameters encompassed demographics, vital signs, laboratory values, clinical scores and physician diagnoses. The two primary outcomes considered were mortality and complexity. We developed ML models to predict polytrauma mortality or complexity using four ML algorithms, including Support Vector Machine (SVM), Random Forest (RF), Artificial Neural Network (ANN) and eXtreme Gradient Boosting (XGBoost). We assessed the models' performance and compared the optimal ML model against three existing trauma evaluation scores, including Injury Severity Score (ISS), Trauma Index (TI) and Glasgow Coma Scale (GCS). In addition, we identified several important clinical predictors that made contributions to the prognostic models. The XGBoost-based polytrauma mortality prediction model demonstrated a predictive ability with an accuracy of 90% and an F-score of 88%, outperforming SVM, RF and ANN models. In comparison to conventional scoring systems, the XGBoost model had substantial improvements in predicting the mortality of polytrauma patients. External validation yielded strong stability and generalization with an accuracy of up to 91% and an AUC of 82%. To predict polytrauma complexity, the XGBoost model maintained its performance over other models and scoring systems with good calibration and discrimination abilities. Feature importance analysis highlighted several clinical predictors of polytrauma complexity and mortality, such as Intracranial hematoma (ICH). Leveraging ML algorithms in polytrauma care can enhance the prognostic estimation of polytrauma patients. This approach may have potential value in the management of polytrauma patients. [ABSTRACT FROM AUTHOR]

Early operative intervention, craniotomy, and/or craniectomy are occasionally warranted in severe traumatic brain injury (TBI). Persistent increased intracranial pressure or accumulation of intracranial hematoma postsurgery can result in higher mortality and morbidity. There is a gap in information regarding the outcome of repeat surgery (RS) in pediatric patients with severe TBI. An observational cohort study titled Approaches and Decisions in Acute Pediatric TBI Trial data was obtained from the Federal Interagency Traumatic Brain Injury Research Informatics System. All pediatric patients who underwent craniotomy or decompressive craniectomy, survived more than 44 hours and were found to have persistent elevated intracranial pressure >20 mmHg for 2 consecutive hours were included in the study. The purpose of the study was to find the outcomes of RS in pediatric severe TBI. Propensity based matching was used to find the outcomes. The primary outcome was 60-day mortality. Out of 1000 total patients enrolled in the Approaches and Decisions in Acute Pediatric Trial, 160 patients qualified for this study. Propensity score matching created 13 pairs of patients. There were no significant differences found between the groups who had RS versus those who did not have repeat surgery on baseline characteristics. There were no significant differences found between the groups regarding 60-day mortality, median hospital days, median intensive care unit days, and 6-month favorable outcome on Glasgow Outcome Scale Extended score. There was no difference in mortality between patients who underwent a second surgery and patients who did not have to undergo a second surgery. [ABSTRACT FROM AUTHOR]

Background and Objectives: In recent years, electronic scooters (e-scooters) have gained popularity, whether for private use or as a publicly available transportation method. With the introduction of these vehicles, reports of e-scooter-related accidents have surged, sparking public debate and concern. The aim of this study was to analyze the epidemiological data, characteristics, and severity of traumatic brain injury (TBI) related to e-scooter accidents. Materials and Methods: This retrospective case series evaluated patients who were admitted to the three largest neurosurgery clinics in Riga, Latvia, from the time period of April to October in two separate years—2022 and 2023—after e-scooter-related accidents. The data were collected on patient demographics, the time of the accident, alcohol consumption, helmet use, the type of TBI, other related injuries, and the treatment and assessment at discharge. Results: A total of 28 patients were admitted with TBI related to e-scooter use, with a median age of 30 years (Q1–Q3, 20.25–37.25), four individuals under the age of 18, and the majority (64%) being male. In 23 cases, the injury mechanism was falling, in 5 cases, collision. None were wearing a helmet at the time of the injury. Alcohol intoxication was evident in over half of the patients (51.5%), with severe intoxication (>1.2 g/L) in 75% of cases among them. Neurological symptoms upon admission were noted in 50% of cases. All patients had intracranial trauma: 50% had brain contusions, 43% traumatic subdural hematoma, and almost 30% epidural hematoma. Craniofacial fractures were evident in 71% of cases, and there were fractures in other parts of body in three patients. Six patients required emergency neurosurgical intervention. Neurological complications were noted in two patients; one patient died. Conclusions: e-scooter-related accidents result in a significant number of brain and other associated injuries, with notable frequency linked to alcohol influence and a lack of helmet use. Prevention campaigns to raise the awareness of potential risks and the implementation of more strict regulations should be conducted. [ABSTRACT FROM AUTHOR]

Introduction: Evidence supports the clinical applicability of near-infrared spectroscopy (NIRS) in intracranial hematoma detection in prehospital settings. This systematic review and meta-analysis aimed to determine the diagnostic yield of NIRS for detecting intracranial hematoma in traumatic brain injury (TBI) patients. Methods: A systematic search was performed in July 2024 in Medline, Embase, Scopus, and Web of Science databases. We included studies that evaluated the diagnostic performance of NIRS in detecting intracranial hematoma in both adult and pediatric patients suspected of TBI in prehospital or emergency settings, using brain computed tomography (CT) scan or magnetic resonance imaging as the gold standard. Results: Eighteen studies enrolling 2979 patients were included. NIRS exhibited an Area Under the Curve (AUC) of 0.91 (95% confidence interval [CI]: 0.88, 0.93), with a sensitivity of 0.86 (95% CI: 0.78, 0.91), and specificity of 0.82 (95% CI: 0.72, 0.89) across all age groups. In children, the results demonstrated an AUC of 0.92 (95% CI: 0.89, 0.94), sensitivity of 0.95 (95% CI: 0.21, 1.00), and specificity of 0.81 (95% CI: 0.65, 0.91). Among adults, the AUC was 0.91 (95% CI: 0.88, 0.93), with sensitivity and specificity of 0.86 (95% CI: 0.78, 0.92) and 0.83 (95% CI: 0.70, 0.91), respectively. Performance improved when NIRS was operated by non-physicians (AUC = 0.94 [95% CI: 0.91, 0.96], sensitivity = 0.90 [95% CI: 0.79, 0.95], specificity = 0.85 [95% CI: 0.71, 0.93]) compared to physicians (AUC = 0.90 [95% CI: 0.87, 0.92], sensitivity = 0.88 [95% CI: 0.77, 0.94], specificity = 0.75 [95% CI: 0.59, 0.76]). Patients' age group and operator type were identified as potential sources of heterogeneity. Sensitivity analyses confirmed the robustness of the findings, particularly in mild TBI cases and studies implementing a ΔOD > 0.2 as the threshold for a positive NIRS result. Conclusion: NIRS proves to be an effective diagnostic tool for detecting traumatic intracranial hematoma in both pediatric and adult groups, with high sensitivity and specificity. Its utility in prehospital triage, operated by physicians or paramedics, underscores its potential for broader clinical application.

Complications of immune thrombocytopenia (ITP) are more frequent at a platelet count lower than 10,000/μL of blood. Intracranial hematoma (ICH) is one of the most severe complications of ITP. Subdural hematoma (SDH) and subarachnoid hemorrhage (SAH) usually occur as extensions of ICH and is generally spontaneous in nature. We report a case of ICH along with SDH and SAH who presented with critically low platelet count managed using apheresis platelet transfusion, desmopressin, intravenous immunoglobulin, and methylprednisolone. The patient was discharged successfully from hospital without any neurological deficit. The importance of early referral and immediate aggressive management and monitoring at an advanced center is suggested.

Abstract Introduction Intracranial hematoma is the collection of blood in various intracranial spaces. Knowledge of patterns, origins, causes and outcomes of ICH conditions is important for decision-making for urgent surgical interventions such as craniotomy and hematoma evacuations. No prior study was conducted in our setup. Hence, this study aimed to assess the patterns and management outcomes of intracranial hematomas in low-resource setting and tailored our management approach at Jimma University Medical center. Methods An institution-based prospective observational study was conducted at Jimma University Medical Center, Ethiopia, for six consecutive months from June to December 2020. Different data sources and interview methods were used and analyzed using SPSS version 24. A bivariate and multivariate logistic regression was conducted to determine the association between the variables. Results A total of 91 eligible patients were recruited during the study period, with a mean age of 34 years. The majority of patients were males [73 (80.2%)] and more common in reproductive age groups (62.6%), from rural areas (50.5%). About 93.4% of patients reported a history of trauma, and road traffic accidents & fighting account for 63.8% of the trauma cases. Sixty-five percent of patients arrive in the hospital within 24 h. Upon presentation, there were loss of consciousness (48.4%), convulsion (11%), aspiration (9.9%) and increased ICP (12%). The majority (49.5%) of the patients had a mild head injury. The focal neurologic deficits were hemiparesis (29.7%) and hemiplegia (5.5%). Acute epidural hematoma (68.1%) was a common finding, followed by sub-acute subdural hematoma. Of the total study participants, 11% had died. All the surviving patients were accessed at 30 days after discharge and re-assessed, 66 patients had good neurologic recovery (62 upper and 4 lower good recovery), 11 patients had moderate disability (7 lower and 4 upper-moderate disabilities), two patients had a severe disability, and two patients (among those with severe disability) had died. Conclusion Trauma was invariably the cause of intracranial hematoma, and patients with low GCS, papillary abnormalities, aspiration and increased ICP had an increased risk of dying from their illness. It is good to formulate policies to enhance injury prevention and bring about health-oriented behavioral change.

Acute & chronic intracranial subdural hematoma is usually caused by trauma. However, it is a rare and serious complication after spinal anesthesia. A 38-year-old woman was brought to the emergency department by her relatives with complaints of sudden change in consciousness. It was learned that the patient gave birth by cesarean section under spinal anesthesia 3 days ago. It was anamnesized that there was no abnormality in the operation, the patient had a headache during the follow-up in the service and was diagnosed as post-dural puncture headache, analgesics were prescribed and she was discharged with recommendations. It was determined that the headaches continued after discharge and sudden change in consciousness occurred 2 hours after discharge. On physical examination, the patient was intubated because of poor general condition and Glasgow coma scale score of 8. The patient had 4/2 anisocoria on the left side. A brain CT scan showed a 6 mm subacute subdural hematoma in the left frontotemporoparietal region at the widest part. There was an 8 mm shift effect to the right of the midline, the sulci were obliterated and the cerebral tissue was mildly edematous. The patient was consulted to neurosurgery because of subacute subdural hematoma, shifting and anisocoria and was transferred to neurosurgery intensive care unit for emergency craniotomy and hematoma evacuation. This case report describes an acute subdural hematoma after spinal anesthesia and emphasizes that when using spinal anesthesia, it should be kept in mind that headache does not always mean hypotensive headache associated with spinal anesthesia and that a catastrophic complication of subdural hematoma may also occur. [ABSTRACT FROM AUTHOR]

Case Presentation: We present a case of a 10-year-old male who developed an atraumatic, nasal septal hematoma with abscess following several days of rhinorrhea and cough. His chief complaint to the emergency department was a two-day history of nasal swelling and discomfort, associated with difficulty breathing through his nose. The patient was well-appearing with swelling and tenderness along the external nasal ridge and nasal septal swelling that occluded both nares. Contrast-enhanced maxillofacial computed tomography revealed a rim-enhancing, fluid-filled collection to the anterior nasal septum. The patient underwent successful incision and drainage by otolaryngology. Discussion: Infected septal hematomas are rare but important to recognize as they can result in septal deformity and potentially life-threatening sequelae, such as intracranial infections. Most are secondary to nasal trauma in adult patients. This case highlights a unique presentation of atraumatic septal hematoma with abscess formation in an immunocompetent pediatric patient. [ABSTRACT FROM AUTHOR]

Background: To review the treatment and the causes of postoperative epidural hematoma (PEDH) after intracranial tumor resection. Method: A retrospective case study was conducted to examine a series of patients who developed PEDH as a complication following intracranial tumor resection between January 2016 and June 2021. The study collected data from hospital charts, including clinical status at admission, imaging results, histopathologic findings, surgical management, complications, and outcomes. Causes of PEDH were evaluated through a review of operative notes and discussions with the surgical team. Results: Twenty-five patients (10 males, 15 females; median age 42 years, range 11–61 years; median medical history 27 months, range 1–96 months) were enrolled in the study. Regarding tumor location, 16 cases exhibited supratentorial brain tumors, 4 cases had infratentorial brain tumors, 2 cases of tumors occurred in the petroclival region, 2 cases in the peritorcular region, and 1 case in the pineal region. Four of these cases were complicated with supratentorial hydrocephalus. The 25 cases in this study were classified into four types based on location. Type 1 refers to EDHs that occur at the adjacent site of the operative field without involvement of the surgical area. Type 2 includes hematomas that occur at the adjacent site of the surgical area and the surgical area. Type 3 includes EDHs that occur in distant areas, and type 4 involves EDHs in the surgical field. The numbers of cases of types 1, 2, 3, and 4 PEDHs were 16, 2, 3, and 4 cases, respectively. Most PEDHs were associated with reduced ICP after craniotomy due to intracranial tumor resection and substantial loss of CSF. All patients achieved satisfactory outcomes after hematoma evacuation. Conclusion: The decrease in ICP resulting from intracranial tumor resection and CSF loss might lead to PEDHs. By employing optimized surgical techniques and meticulous patient management to prevent rapid decreases in ICP and dural detachment, we can potentially lower the incidence of PEDHs. Additionally, prompt evacuation of hematomas can contribute to positive outcomes. [ABSTRACT FROM AUTHOR]

In resource-limited settings, the standard of care prescribed in developed countries for either operative or nonoperative management of traumatic intracranial hematomas (TICHs) frequently has to be adapted to the economic and infrastructural realities. This study aims to present the outcome of selected cases of TICHs managed nonoperatively without routine intensive care unit admission, repeated cranial computed tomography (CT) scan or intracranial pressure monitoring at a rural neurosurgical service in a developing country. This was a retrospective analysis of a cohort of our patients with cranial CT-confirmed TICHs selected for nonoperative treatment from our prospective head injury (HI) register over a 42-month period. There were 67 patients (51 males) in this study with a mean age of 38.6 (standard deviation, 17.6) years, having mild HI in >half, (55.2%, 37/67) and anisocoria in 22.4% (15/67). Road traffic accident was the most common (50/67, 74.7%) trauma etiology. Isolated acute-subdural hematoma, intracerebral hemorrhage, and epidural hematoma occurred in 29.9%, 25.4%, and 22.4% of the patients respectively. Only 2 of 8 patients in whom intensive care unit admission was deemed necessary could afford admission. Repeat cranial CT scan was requested in 8 patients (8/67, 11.9%); only 5 of these could afford the investigation. The outcome of care was good in 82.1% patients (55/67). Increasing severity of the HI (P < 0.01) and presence of pupillary abnormality (P = 0.03) were significant predictors of poor outcome. In a Nigerian rural neurosurgery practice, nonoperative management of a well-selected cohort of TICHs was attended by acceptable level of favorable outcome. [ABSTRACT FROM AUTHOR]

A retrospective analysis of surgical treatment data was carried out in 120 patients with severe combined cranio-abdominal trauma, including 86 men (71.7%) and 34 women (28.3%) (average age 37.5 ± 5.90 years), delivered to the clinic within 2 hours from the moment of injury in the period 2019-2022. The most frequent combinations of injuries were abdominal and head injury (62.3%), abdominal and limb injury (58.7%), chest and abdominal injury (57.1%). On average, there were 1.62 ± 0.03 injuries to the abdominal cavity and retroperitoneal space per patient. Laparoscopy was the final method of diagnosis and treatment of abdominal injuries in 86 patients (71.7%). [ABSTRACT FROM AUTHOR]

Objectives: Traumatic intracranial hematomas represent a critical clinical situation where early detection and management are of utmost importance. Machine learning has been recently used in the detection of neuroradiological findings. Hence, it can be used in the detection of intracranial hematomas and furtherly initiate a management cascade of patient transfer, diagnostics, admission, and emergency intervention. We aim, here, to develop a diagnostic tool based on artificial intelligence to detect hematomas instantaneously, and automatically start a cascade of actions that support the management protocol depending on the early diagnosis. Materials and Methods: A plot was designed as a staged model: The first stage of initiating and training the machine with the provisional evaluation of its accuracy and the second stage of supervised use in a tertiary care hospital and a third stage of its generalization in primary and secondary care hospitals. Two datasets were used: CQ500, a public dataset, and our dataset collected retrospectively from our tertiary hospital. Results: A mean dice score of 0.83 was achieved on the validation set of CQ500. Moreover, the detection of intracranial hemorrhage was successful in 94% of cases for the CQ500 test set and 93% for our local institute cases. Poor detection was present in only 6-7% of the total test set. Moderate false-positive results were encountered in 18% and major false positives reached 5% for the total test set. Conclusion: The proposed approach for the early detection of acute intracranial hematomas provides a reliable outset for generating an automatically initiated management cascade in high-flow hospitals. [ABSTRACT FROM AUTHOR]

Traumatic brain injuries are a global problem, with more than 50 million people suffering from brain injuries every year. A frequent consequence of severe traumatic brain injury is intracranial hematoma (ICH), causing mortality, disability, post-traumatic epilepsy. ICH has different clinical manifestations and physical characteristics. Standard treatment for ICH includes conservative monitoring for small volume hematomas or surgical evacuation of the hematoma. Craniotomy is often used to remove hematomas, because acute and subacute hematomas contain clots, and drainage of the hematoma cavity alone is not enough. In chronic hematomas, drainage through a hole is usually used, but this is effective only if the hematoma is represented by one cavity and its contents are completely liquid, which is not always the case. Thus, widely used techniques do not always meet modern requirements for effectiveness and low invasiveness of surgical treatment.The review considers endoscopic methods of surgical treatment for all variants of traumatic ICH; 31 publications have been found on this topic, mentioning 602 interventions. Differences in patient selection criteria make it difficult to compare the methods and outcomes. From the technical point of view, the procedures were also very diverse. The article analyzes the main features of different authors’ methods.None of the authors comes to the conclusion about outcome worsening after endoscopic intervention. With regard to acute and subacute hematomas, there are currently no reliable statistical data, but the results obtained can generally be assessed as positive.In acute and subacute hematomas, endoscopic intervention is perceived by the authors not as providing more opportunities, but only as a less invasive replacement for conventional craniotomy. In chronic hematomas, endoscopic intervention is considered to have more opportunities and advantages over the standard treatment.At present, the widespread use of endoscopic minimally invasive methods of surgical treatment for traumatic hematomas is hampered mainly by the lack of clear criteria for selecting patients and well-established methods of intervention. More high-quality research is needed to determine the role of these methods in general clinical practice.

Modern classification of traumatic brain injury with identification of clinical and morphological variants is provided. Neurological semiotics and neuroimaging diagnosis of concussion, mild, moderate and severe cerebral contusion, compression of the brain with epidural, subdural and intracerebral hematomas are described based on the analysis of observations of the National Medical Research Center for Neurosurgery named after Academician N.N. Burdenko.

Complications of immune thrombocytopenia (ITP) are more frequent at a platelet count lower than 10,000/μL of blood. Intracranial hematoma (ICH) is one of the most severe complications of ITP. Subdural hematoma (SDH) and subarachnoid hemorrhage (SAH) usually occur as extensions of ICH and is generally spontaneous in nature. We report a case of ICH along with SDH and SAH who presented with critically low platelet count managed using apheresis platelet transfusion, desmopressin, intravenous immunoglobulin, and methylprednisolone. The patient was discharged successfully from hospital without any neurological deficit. The importance of early referral and immediate aggressive management and monitoring at an advanced center is suggested. [ABSTRACT FROM AUTHOR]

Jiawei Cai,1– 3,&ast; Chao He,4,&ast; Jiaheng Xu,1– 3,&ast; Qiu He,1– 3 Jinye Su,1– 3 Zanyi Wu,1– 3 Yawen Xu1– 3 1Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China; 2Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China; 3Fujian Provincial Institutes of Brain Disorders and Brain Sciences, First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China; 4Department of Neurosurgery, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yawen Xu; Zanyi Wu, Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, Fujian, 350005, People’s Republic of China, Email xuyawen121314@163.com; kirby98@126.comObjective: To identify whether intracranial hematoma (ICH) evacuation improves the prognosis of patients with ruptured anterior communicating artery (AcomA) aneurysms concomitant with small ICHs (≥ 10 mL and < 25 mL).Methods: Data on patients diagnosed with small ICHs secondary to ruptured AcomA aneurysms who underwent surgery in our department between January 2010 and February 2018 was retrospectively analyzed. The patients were divided into two groups based on whether the hematoma was evacuated. The modified Rankin Scale (mRS) was used to assess prognosis six months after onset.Results: The study recruited 58 patients, 19 of whom underwent aneurysm clipping and ICH evacuation. While 33 patients underwent aneurysm clipping, 6 patients underwent coiling embolism without ICH evacuation. The average ICH volume was 15.27± 4.07 mL. In the hematoma-evacuated group, 13 (68.4%) patients had unfavorable outcomes (mRS scores of 4 to 6). In the non-evacuated hematoma group, 13 (33.3%) patients had unfavorable outcomes (P = 0.001), postoperative infarction occurred in 11 (57.9%) patients in the hematoma evacuation group and 9 (23.1%) patients in the other group (P = 0.009).Conclusion: ICH evacuation was associated with unfavorable outcomes and postoperative infarction in ruptured AcomA aneurysms with concomitant small hematomas (< 25 mL). Aneurysm clipping or coiling without ICH evacuation may be a safe and effective choice; however, further investigation is needed.Keywords: AcomA aneurysms, intracranial hematoma, infarction, prognosis, ICH evacuation

Objectives: Ultrasound Needle, which is an improved ultrasonic horn device, has shown great potential for promoting the diffusion of thrombolytic drugs within clots and enhancing clot lysis efficiency. However, the clot lysis efficiency of different thrombolytic drugs with the synergy of Ultrasound Needle remains unknown. In this study, we aimed to compare the lysis efficiency of the non-fibrin-specific drug urokinase and fibrin-specific drug reteplase with the synergy of Ultrasound Needle. Materials and methods: Twenty-five milliliters of human blood was incubated for 1.5 h to form in vitro clots and then received the corresponding treatment protocols: control group (normal saline), US group (10 min of Ultrasound Needle treatment), UK group (30000IU of urokinase), r-PA group (2 mg of reteplase), US + UK group, and US + r-PA group. After treatment, the morphological changes of the clots were analyzed by B-mode ultrasound imaging and hematoxylin and eosin (H&E) staining. Lysis efficiency was evaluated based on the relative end weight (final weight/initial weight). The fibrin density of the different groups after treatment was assessed by immunofluorescence staining. Results: Morphological examination and relative end weight analysis showed that combination therapies induced a more thorough dissolution of clots compared with single therapies, and the US + r-PA group exhibited higher lysis efficiency than the US + UK group. In addition, immunofluorescence staining showed that the US + r-PA group had fewer remaining thrombus fibrins than the US + UK group after treatment. Conclusions: The Ultrasound Needle can significantly improve the clot lysis efficiency of both fibrinolytic drugs, and fibrin-specific reteplase exhibited superior lysis efficiency over non-fibrin-specific urokinase with the synergy of the Ultrasound Needle.

Chronic subdural hematoma (CSH) in the posterior fossa is extremely rare in the adult population. CT scanning is generally accurate and sufficiently sensitive in the diagnosis of supratentorial subdural hematomas, while MRI has clearly shown its superiority in the detection of subdural collections at unusual locations and particularly in the detailed analysis of the posterior cranial fossa. The surgical strategy is still controversial. We report a case of CSH in the posterior fossa successfully treated with a suboccipital craniectomy. A 70-year-old man; has developed headaches, nausea, cerebellar syndrome and ataxia of walking. Radiological examinations revealed the appearance of a right CSH in the posterior fossa associated with hydrocephalus. Upon rapid deterioration of the patient's consciousness, urgent treatment was required. A small right suboccipital craniectomy was to access the hematoma. Postoperative computed tomography showed that the CSH and hydrocephalus had been successfully treated. [ABSTRACT FROM AUTHOR]

Cardiac complications are related to poor prognosis after spontaneous intracerebral hemorrhage (ICH). This study aims to predict the cardiac complications arising from small intracranial hematoma at ultraearly stage. The data of this work were derived from the Risk Stratification and Minimally Invasive Surgery in Acute ICH Patients study (ClinicalTrials.gov Identifier: NCT03862729). This work included patients with ICH but without brain herniation, as confirmed by a brain computed tomography scan within 48 hours of symptom onset. Every Patient's information recorded at the emergent department, including clinical, laboratory, electrocardiogram, and medical records, was derived from the electronic data capture. Cardiac complications were defined as the occurrence of myocardial damage, arrhythmias, and ischemic electrocardiogram changes during hospitalization. Variables associated with cardiac complications were filtrated by univariate and multivariate regression analyses. Independent risk factors were used to form the early predictive model. The restricted cubic splines were employed to investigate the nonlinear associations in a more sophisticated and scholarly manner. A total of 587 ICH patients were enrolled in this work, including 72 patients who suffered from cardiac complications after ICH. Out of the 78 variables, 24 were found to be statistically significant in the univariate logistic regression analysis. These significant variables were then subjected to multivariate logistic regression analysis and utilized for constructing risk models. Multivariate logistic regression analysis showed high plasma fibrinogen (FIB) level [odds ratio (OR) per standard deviation (SD) 1.327, 95% confidence intervals (CI) 1.037–1.697; P = 0. 024)] and older age (OR per SD 1.777, 95% CI 1.344–2.349; P ＜0.001) were associated with a higher incidence of cardiac complications after ICH. High admission pulse rate (OR 0.620, 95% CI 0.451–0.853; P = 0. 003) was considered a protective factor for cardiac complications after ICH. In the restricted cubic spline regression model, FIB and cardiac complications following ICH were positively correlated and almost linearly (P for nonlinearity = 0.073). The reference point for FIB in predicting cardiac complications after ICH was 2.64 g/L. Emergent factors, including plasma FIB level, age, and pulse rate, might be independently associated with cardiac complications after ICH, which warrants attention in the context of treatment. [ABSTRACT FROM AUTHOR]

Background: Percutaneous balloon compression is a safe and effective treatment for trigeminal neuralgia. Current technique consists of penetrating the foramen ovale using a sharp 14G needle with a stylet. Difficulty of cannulation of the foramen ovale, failures of cannulation and major neurovascular complications of the procedure, although rare, may be due to the relatively large caliber of this needle and its sharp tip. Objective: To present a novel technique to facilitate and make the cannulation of the foramen ovale with a 14G cannula safer. Methods: A rigid blunt-tip guide of 1.2 or 1.5 mm is used to penetrate the foramen ovale under lateral fluoroscopic control. Once the guide enters the foramen it is advanced further to the clival line, and a 14G cannula is then advanced over the guide to engage the foramen, at which point the guide is withdrawn and replaced with the balloon catheter. Results: The technique was employed to deliver a 4F balloon catheter to Meckel's cave successfully in 500 consecutive procedures performed on 416 trigeminal neuralgia patients. None of the patients had neurovascular complications like facial hematoma, arterial injury, carotid-cavernous fistula or cranial nerve palsies. Conclusion: A novel technique for cannulation of the foramen ovale is described. The use of blunt tip guides of smaller diameters instead of sharp 14G needles considerably facilitated cannulation of the foramen ovale and enabled cannulation in all cases. Absence of complications of cannulation such as facial hematoma, carotid-cavernous fistula or intracranial hemorrhage in this series of patients suggests that the technique may be safer than the use of conventional sharp tipped 14G needles in terms of avoiding neurovascular complications. [ABSTRACT FROM AUTHOR]

Epidural hematoma (EDH) is found in 1-4% of traumatic brain injury cases. Acute triple extradural hematoma is a rare presentation of head trauma injury. In sporadic cases, they represent 0.5-1% of all extradural hematomas. Here is a case report of a 36-year-old female patient who presented to us with a head injury due to fall from a bike due to collision with a stray animal. The patient had a Glasgow Coma Scale of 9 (E2V2M5) with bilateral sluggishly reacting pupil to light. Computed tomography showed asymmetric bilateral posterior fossa EDHs along with an extradural hematoma in the right frontal region with multiple small contusions with mass effect. The surgical evacuation was performed first of the posterior fossa in the prone position and then right frontal hematoma evacuation in the supine position in the same sitting. The patient recovered well and was discharged on the 10th post-operative day with no neurological deficit. Early drainage of hematomas has been demonstrated to be an effective technique that soon decreases the intracranial pressure and promotes an efficient resolution to the neurological damage. [ABSTRACT FROM AUTHOR]

Cerebral ventriculitis is a life-threatening condition that requires prompt and effective pharmacological intervention. The continuous irrigation of the cerebral ventricles with fluid and its drainage is a system to remove toxic substances and infectious residues in the ventricles; this system is called IRRAflow®. We used this kind of ventricular irrigation/drainage system to treat two patients with post-surgical cerebral ventriculitis and a patient with bacterial meningitis complicated with ventriculitis. In this case series, we discuss the management of these three cases of cerebral ventriculitis: we monitored cytochemical parameters and cultures of the cerebrospinal fluid of patients during their ICU stay and we observed a marked improvement after irrigation and drainage with IRRAflow® system. Irrigation/drainage catheter stay, mode settings, and antibiotic therapies were different among these three patients, and neurological outcomes were variable, according to their underlying pathologies. IRRAflow® system can be applied also in other types of brain injury, such as intraventricular hemorrhage, intracranial abscess, subdural hematomas, and intracerebral hemorrhage, with the aim to remove the hematic residues and enhance the functional recovery of the patients. IRRAflow® seems a promising and useful tool to treat infectious and hemorrhagic diseases in neuro-intensive care unit. [ABSTRACT FROM AUTHOR]

Background Various high-energy tasks in the construction industry can lead to craniocerebral injuries. Construction industry–associated penetrating craniocerebral injuries due to metal foreign bodies have unique characteristics. However, no norms exist for removing metal foreign bodies and preventing secondary trauma. This study aimed to explore the characteristics and treatment of construction industry–associated penetrating craniocerebral injuries due to metal foreign bodies. Methods Data of patients who suffered from penetrating injuries due to metal foreign bodies and were treated in the Zhongshan People's Hospital from 2001 to 2021 were collected based on the causes of injuries to explore disease characteristics and therapeutic effects. Results A total of six patients with penetrating craniocerebral injuries due to metal foreign bodies, who underwent surgeries, were included in the study. Five patients recovered well after the surgery, and one patient died. In four patients, intracranial infection complicated the course after surgery, and two patients had delayed intracranial hematoma. Conclusion Patients with construction industry–associated penetrating craniocerebral injuries due to metal foreign bodies are prone to coma and intracranial vascular injuries. Early surgical removal and prevention of intracranial infection are key to achieving good therapeutic effects. [ABSTRACT FROM AUTHOR]

Objective To summarize the cases of hematoma in remote site after infratentorial craniotomy for tumors, and to explore the early identification methods as well as prevention and treatment strategies. Methods The clinical data of patients who underwent infratentorial craniotomy for tumors from Dec 2019 to Nov 2021 in the skull base subspecialty group of the department of neurosurgery, Huashan Hospital, Fudan University were retrospectively analyzed to summarize the location and type of hematoma in remote sites and its causes，and to explore its early identification methods and prevention strategies. Results Among the 490 patients who underwent infratentorial craniotomy for tumors，18 patients （3.67%） developed hematoma in remote site, including 9 cases with supratentorial subdural hematoma，3 cases with occipital epidural hematoma，2 cases with supratentorial subdural hematoma combined with interhemispheric subdural hematoma，2 cases with intraventricular hematoma，1 cases with interhemispheric subdural hematoma, and 1 patient temporal lobe intracerebral hematoma combined with subarachnoid hemorrhage. Two cases were accurately identified during operation, and the operation was terminated. Intraoperative head CT was performed to determine the type of hematoma, and surgical treatment was performed. All the other 16 cases were identified in the early postoperative period, and head CT was performed to identify the type of hematoma. One patient was treated with surgery and 15 cases were treated conservatively. All the 18 cases were followed up for 2-21 months after operation, and there was no death case. Conclusion The hematoma in remote site after infratentorial craniotomy for tumors is a rare and serious threat to the safety of surgery, mostly manifested as supratentorial subdural hematoma, epidural hematoma, intraventricular hematoma, interhemispheric subdural hematoma and intracerebral hematoma, which can be associated with subarachnoid hemorrhage. Perioperative active prevention, early and accurate identification as well as timely and effective treatment can significantly improve the prognosis of patients. [ABSTRACT FROM AUTHOR]

Objective: To date, there is no consensus on the surgery strategies of cranioplasty (CP) and ventriculoperitoneal shunt (VPS) placement. This meta‐analysis aimed to investigate the safety of staged and simultaneous operation in patients with comorbid cranial defects with hydrocephalus to inform future surgery protocols. Methods: A meta‐analysis of PubMed, Ovid, Web of Science, and Cochrane Library databases from the inception dates to February 8, 2023 adherent to PRISMA guidelines was conducted. The pooled analyses were conducted using RevMan 5.3 software. The outcomes included postoperative infection, reoperation, shunt obstruction, hematoma, and subdural effusion. Results: Of the 956 studies initially retrieved, 10 articles encompassing 515 patients were included. Among the total patients, 193 (37.48%) and 322 (62.52%), respectively, underwent simultaneous and staged surgeries. The finding of pooled analysis indicated that staged surgery was associated with lower rate of subdural effusion (14% in the simultaneous groups vs. 5.4% in the staged groups; OR = 2.39, 95% CI: 1.04–5.49, p = 0.04). However, there were no significant differences in overall infection (OR = 1.92, 95% CI: 0.74–4.97, p = 0.18), central nervous system infection (OR = 1.50, 95% CI: 0.68–3.31, p = 0.31), cranioplasty infection (OR = 1.58, 95% CI: 0.50–5.00, p = 0.44), shunt infection (OR = 1.30, 95% CI: 0.38–4.52, p = 0.67), reoperation (OR = 1.51, 95% CI: 0.38–6.00, p = 0.55), shunt obstruction (OR = 0.73, 95% CI: 0.25–2.16, p = 0.57), epidural hematoma (OR = 2.20, 95% CI: 0.62–7.86, p = 0.22), subdural hematoma (OR = 1.20, 95% CI: 0.10–14.19, p = 0.88), and intracranial hematoma (OR = 1.31, 95% CI: 0.42–4.07, p = 0.64). Moreover, subgroup analysis failed to yield new insights. Conclusions: Staged surgery is associated with a lower rate of postoperative subdural effusion. However, from the evidence of sensitivity analysis, this result is not stable. Therefore, our conclusion should be viewed with caution, and neurosurgeons in practice should make individualized decisions based on each patient's condition and cerebrospinal fluid tap test. [ABSTRACT FROM AUTHOR]

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Ossified intracranial meningiomas (OIM) and ossified spinal meningiomas (OSM) are rare neoplasms of mesenchymal origin that predominantly manifest in the spinal cord and infrequently in the cranial region, accounting for -0. 7-5.5% of all meningiomas. It is extremely rare to have multiple intracranial and spinal lesions accompanied by ossification. Herein, we report this rare case for the first time. A 34-year-old woman presented with paresthesia and limb weakness in the right lower limb and gradually worsened. Approximately half a year later, she could only walk with crutches. Magnetic resonance imaging of the brain and spinal cord showed multiple meningiomas, and histopathological examination confirmed multiple OIM and OSM (WHO grade 1). Multiple OIM and OSM are extremely rare with diverse imaging features, and it is easily confused with other tumors. Histopathological examination is the final diagnostic method. [ABSTRACT FROM AUTHOR]

Background: Expansive intracranial hematomas (EIH) following traumatic brain injury (TBI) continue to be a public health problem in Uganda. Data is limited regarding the neurosurgical outcomes of TBI patients. This study investigated the neurosurgical outcomes and associated risk factors of EIH among TBI patients at Mulago National Referral Hospital (MNRH). Methods: A total of 324 subjects were enrolled using a prospective cohort study. Socio-demographic, risk factors and complications were collected using a study questionnaire. Study participants were followed up for 180 days. Univariate, multivariable, Cox regression analyses, Kaplan Meir survival curves, and log rank tests were sequentially conducted. P-values of < 0.05 at 95% Confidence interval (CI) were considered to be statistically significant. Results: Of the 324 patients with intracranial hematomas, 80.6% were male. The mean age of the study participants was 37.5 ± 17.4 years. Prevalence of EIH was 59.3% (0.59 (95% CI: 0.54 to 0.65)). Participants who were aged 39 years and above; PR = 1.54 (95% CI: 1.20 to 1.97; P = 0.001), and those who smoke PR = 1.21 (95% CI: 1.00 to 1.47; P = 0.048), and presence of swirl sign PR = 2.26 (95% CI: 1.29 to 3.95; P = 0.004) were found to be at higher risk for EIH. Kaplan Meier survival curve indicated that mortality at the 16-month follow-up was 53.4% (95% CI: 28.1 to 85.0). Multivariate Cox regression indicated that the predictors of mortality were old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having GOS < 3, QoLIBRI < 50, SDH, contusion, and EIH. Conclusion: EIH is common in Uganda following RTA with an occurrence of 59.3% and a 16-month higher mortality rate. An increased age above 39 years, smoking, having severe systemic disease, and the presence of swirl sign are independent risk factors. Old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having a GOS < 3, QoLIBRI < 50, ASDH, and contusion are predictors of mortality. These findings imply that all patients with intracranial hematomas (IH) need to be monitored closely and a repeat CT scan to be done within a specific period following their initial CT scan. We recommend the development of a protocol for specific surgical and medical interventions that can be implemented for patients at moderate and severe risk for EIH. [ABSTRACT FROM AUTHOR]