Abstract:
BACKGROUND:Although the majority of patients with minimal acute subdural hematomas (aSDHs) can be managed conservatively, some require delayed aSDH evacuation due to hematoma enlargement. This study was designed to determine the risk factors associated with delayed hematoma enlargement leading to surgery in patients with aSDHs who did not initially require surgical intervention. METHODS:From 2002 to 2012, 98 patients were treated for nonoperative aSDHs following mild head injury (Glasgow Coma Scale scores of 13-15). The outcome variables were radiographic evidence of SDH enlargement on serially obtained computed tomography (CT) images and later surgical evacuation. Univariate and multivariate analyses were applied to both the demographic and initial radiographic features to identify risk factors for SDH progression and surgery. RESULTS:Overall, 64 patients (65 %) revealed minimal SDH or spontaneous hematoma resolution (conservative group) with conservative management at their last follow-up CT scan. The remaining 34 patients (35 %) received delayed hematoma evacuation (delayed surgery group) a median of 17 days after the head trauma. There were no significant differences between the two groups for baseline characteristics, including age, injury type, degree of brain atrophy, prior history of antithrombotic drugs, and coagulopathy. The presence of cerebral contusions and subarachnoid hemorrhages was more common in the conservative group (p = 0.003 and p = 0.003, respectively). On multivariate analysis, hematoma volume (p = 0.01, odds ratio [OR] = 1.094, 95 % confidence interval [CI] = 1.021-1.173) and degree of midline shift (p = 0.01, OR = 1.433, 95 % CI = 1.088-1.888) on the initial CT scan were independently associated with delayed hematoma evacuation. CONCLUSIONS:A critical proportion of patients with minimal aSDHs occurring after mild head injury can progress over several weeks and require hematoma evacuation. Especially patients with a large initial SDH volume and accompanying midline shift require careful monitoring of hematoma progression.
journal_name
Acta Neurochir (Wien)journal_title
Acta neurochirurgicaauthors
Kim BJ,Park KJ,Park DH,Lim DJ,Kwon TH,Chung YG,Kang SHdoi
10.1007/s00701-014-2151-4subject
Has Abstractpub_date
2014-08-01 00:00:00pages
1605-13issue
8eissn
0001-6268issn
0942-0940journal_volume
156pub_type
杂志文章abstract:OBJECTIVE:The aim of this work was to retrospectively study the long-term reliability of the common consensus endocrinological criteria for the assessment of postoperative remission of acromegaly. PATIENTS AND METHODS:In 96 consecutive patients, surgical remission of acromegaly following transsphenoidal surgery was co...
journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/s00701-010-0790-7
更新日期:2011-01-01 00:00:00
abstract::Intraoperative real-time ultrasound imaging (US) was used in over 500 patients to investigate which of the previously considered applications are of practical use in everyday neurosurgery. During all intraoperative applications for a wide variety of pathological conditions, small deep-seated as well as subcortically l...
journal_title:Acta neurochirurgica
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abstract:BACKGROUND:Recent advances in endoscopic techniques have allowed minimally invasive approaches to the cranio-vertebral junction (CVJ) through the oropharynx (ETA) in addition to the transnasal approach (EEA). These minimally invasive endoscopic techniques allow for increased surgical exposure using no visible incisions...
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更新日期:2012-08-01 00:00:00
abstract::Incomplete cerebral ischaemia of 10 to 60 minutes duration was performed by reducing the perfusion pressure of completely isolated canine heads at brain temperatures of 37 and 32 degrees C. Complete cerebral ischaemia of the same duration was performed by complete stopping of the perfusion. The latency of recovery of ...
journal_title:Acta neurochirurgica
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abstract:BACKGROUND:Spinal intramedullary arteriovenous malformations (AVMs) fed by an anterior spinal artery are surgically challenging vascular lesions. METHOD:We herein presented microsurgical resection techniques for an intramedullary glomus AVM located in the lateral part of the high cervical spinal cord with an operative...
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journal_title:Acta neurochirurgica
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journal_title:Acta neurochirurgica
pub_type: 杂志文章,随机对照试验
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更新日期:2015-02-01 00:00:00
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更新日期:2013-10-01 00:00:00
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journal_title:Acta neurochirurgica
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更新日期:2021-01-06 00:00:00
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journal_title:Acta neurochirurgica
pub_type: 杂志文章
doi:10.1007/BF01405275
更新日期:1989-01-01 00:00:00
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journal_title:Acta neurochirurgica
pub_type: 杂志文章
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更新日期:1991-01-01 00:00:00
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pub_type: 杂志文章
doi:10.1007/BF01405185
更新日期:1993-01-01 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2018-10-01 00:00:00
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更新日期:2009-10-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1981-01-01 00:00:00
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更新日期:1976-01-01 00:00:00
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pub_type: 杂志文章
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更新日期:1978-01-01 00:00:00