Intracranial Calcified Extradural Hematoma about a Case

Introduction: Extradural hematoma is a common pathology in our department. The natural history of small-volume hematoma is usually towards resorption. In rare cases, the hematoma calcifies and compresses the brain. We report an extradural hematoma in a 15-year-old boy who had a road traffic accident on February 2011. The brain CT-scan performed the following day revealed a small right frontal extradural hematoma. During hospitalization, he had a fever of 40 degrees with convulsions and the blood culture isolated the coagulase-negative staphylococci and Group D streptococci. When his conscience was restored, hemiparesis and dysarthria were observed. The control brain CT-scan performed 2 weeks after the trauma showed early resorption of the hematoma. Two months after the trauma, the brain CT-scan showed calcification of the hematoma. He underwent surgery in April 2011 to remove the calcification. The sequels were hemiparesis and posttraumatic epilepsy. Conclusion: The evolution of a small non-operated extradural hematoma can be done towards calcification thus requiring surgery.

Factors affecting outcomes of surgically treated patients with cranial extradural hematoma: A cross-sectional study

Objective: To evaluate the factors resulting in the poor outcomes in patients with extradural hematoma (EDH).Methods: The study was conducted at the Neurosurgery Teaching Hospital in Baghdad with a group of 100 surgically treated EDH patients and was carried prospectively from February 1st, 2015 to May 1st, 2017. The baseline information (gender, age, cause of injury, time interval between injury and reception, Glasgow coma scale, etc.) of the patients was recorded, and the variables affecting the outcomes were analyzed. Results: In the study, 80% of patients were male;54% were between 10-29 years old;the commonest cause of injury was fall accounting for 51%;78% of the patients got good functional recovery, and 10% had a residual disability;12% died. Better functional recovery was found among patients with a shorter time interval (≤3 h) (P=0.001), while the longer time interval (>3 h) increased the residual disability (P=0.005). In addition, functional recovery increased six times with higher Glasgow coma scale (P=0.001), and inversely related to mortality (P=0.005). Conclusions: Age between 10 and 29 years, male gender, and depth of hematoma more than 5 cm are at higher risks of poor outcomes of patients with surgically treated EDH. Neurological conditions on admission and time interval between injury and reception are also important factors.

A novel extradural nerve transfer technique by coaptation of C4 to C5 and C7 to C6 for treating isolated upper trunk avulsion of the brachial plexus

The study aimed to demonstrate the feasibility of an extradural nerve anastomosis technique for the restoration of a C5 and C6 avulsion of the brachial plexus.Nine fresh frozen human cadavers were used.The diameters,sizes,and locations of the extradural spinal nerve roots were observed.The lengths of the extradural spinal nerve roots and the distance between the neighboring nerve root outlets were measured and compared in the cervical segments.In the spinal canal,the ventral and dorsal roots were separated by the dura and arachnoid.The ventral and dorsal roots of C7 had sufficient lengths to anastomose those of C6.The ventral and dorsal of C4 had enough length to be transferred to those of C5,respectively.The feasibility of this extradural nerve anastomosis technique for restoring C5 and C6 avulsion of the brachial plexus in human cadavers was demonstrated in our anatomical study.

Outcomes of Evacuation Extradural Hematoma via Craniotomy under Local Anesthesia

Background: The EDH occurs due to the accumulation of bleeding between the inner table of the skull and the outer layer of the dura mater. It is said to account for 1% - 3% of all head injured patients and 9% of those who are comatose. The only life-saving treatment of choice is evacuation of EDH via craniotomy. Methods: This was a prospective observational study, where 40 patients were in follow-up for determining the outcomes of evacuation via craniotomy. Results: Majority of the patients were young and males. The main outcome of the evacuation was favorable (recovered), but certain unfavorable outcomes were also accounted like mortality. Conclusion: The pre-surgery clinical findings like consciousness of patient were an important indicator for EDH evacuation outcome. In most of the cases, the outcome was favorable with progressive recovery.

Conservative Plan for Post Traumatic Extradural Hematoma: Risk Factors Favouring Conversion to Surgery

Introduction: Extradural hematoma (EDH) is considered one of the most serious and recognized secondary insults of traumatic brain injury (TBI). We will analyse the data of cases required conversion from a conservative to a surgical management and identify the possible patient and disease related risk factors in such cases. Patients and Methods: This prospective study included 90 patients with traumatic EDH, admitted to the Neurotrauma department in Cairo University hospitals from March 2014 to August 2016. Their CT scans reveal EDH alone or with associated cerebral lesions initially fitting the criteria of conservative management. Results: The commonest site is frontal in 21 patients (23.3%), followed by parietotemporal in 18 patients (20%). While Posterior fossa hematomas occurred in 3 cases, which was the least common site (3.3%). The mean size of the EDH was 17.02 ml, with a standard deviation of 6.29 ml. The minimum size was 2 ml and a maximum of 28 ml. The cut off value of the size of the hematoma requiring conversion to a surgical management was 19 ml. Conclusion: Clear indications of EDH evacuation have been well known, however studying which risk factors are more liable to convert conservative management plan to evacuation is important. Increased caution and closer monitoring are required when the size of the hematoma is >19 ml or the hematoma is overlying a venous sinus. Unlike coagulopathy which was found to be a potential risk factor, but larger number study is needed.

Extra Dural Hematoma of the Dorso-Lumbar Region in a Hemophiliac: A Rare Entity

Introduction and objective: Hemophilia is a genetic bleeding disorder inherited as a recessive train linked to the male gender. Bleeding into the central nervous system in patients with hemophilia is an extremely dangerous condition that can be directly life-threatening, if left untreated. Extradural hematoma of the dorso-lumbar region is rare but potentially deadly disease in children. This condition can result in severe neurological deficits. We aim to discuss the clinical, radiological and progressive clinical aspects of this illness. Case report: We report the case of a 5-year-old child with severe hemophilia A treated for extradural hematoma of the dorso-lumbar region resulting from trauma. A spinal magnetic resonance imaging revealed an extradural hematoma. The patient was successfully treated with intensive replacement therapy and did not require surgical intervention. Conclusion: Extradural hematoma is a rare complication of hemophilia, that needs to be looked for in children who have bleeding disorders. For the best neurological outcome, early diagnosis is crucial.

Supra-and infra-tentorial subacute extradural hematoma

Extradural hematoma(EDH)is a rare but serious complication of brain injury.The supra-and infra-tentorial EDH is even rarer and only a few articles focusing on this topic have been published.The clinical manifestations are nonspecific but early diagnosis of supra-and infra-tentorial EDH and prompt treatment are mandatory to avoid complications.We report this case of a supra-and infra-tentorial subacute EDH on a 4 years old child.

How to locate the dural defect in a spinal extradural meningeal cyst: a literature review

Spinal extradural meningeal cysts(SEMCs)are rare lesions of the spinal canal.Although closure of the dural defect can achieve satisfactory therapeutic effects,locating the fistula is difficult.This review summarizes the methods for locating the fistula of SEMCs and the distribution and features of fistula sites.This was a non-systematic literature review of studies on SEMCs.We searched PubMed for English-language articles to summarize the methods of locating the defect.The search words were“epidural arachnoid cyst,”“dural cyst,”“epidural cyst,”and“epidural meningeal cyst.”For the defect location component of the study,case reports,studies with a sample size less than four,controversial ventral dural dissection(s),and undocumented fistula location reports were excluded.Our review showed that radiography and computed tomography(CT)may show changes in the bony structure of the spine,with the largest segment of change indicating the fistula site.Occasionally,magnetic resonance imaging(MRI)can show a cerebrospinal fluid(CSF)flow void at the fistula site.The middle segment of the cyst on sagittal MRI,the largest cyst area,and cyst laterality in the axial view indicate the fistula location.Myelography can show the fistula location in the area of the enhanced cyst and subarachnoid stenosis.Digital subtraction or delayed CT can be used to observe the location of the initial cyst filling.Cine MRI and time-spatial labeling inversion pulse techniques can be used to observe CSF flow.Steady-state image construction interference sequence MRI has a high spatial resolution.Neuroendoscopy,MRI myelography,and ultrasound fistula detection can be performed intraoperatively.Moreover,the fistula was located most often in the T12–L1 segment.Identifying the fistula location is difficult and requires a combination of multiple examinations and experience for comprehensive judgment.

Symptomatic Extra-Dural Arachnoid Cyst

Objective: The aim of this study is to report a case of arachnoid cyst due to mass effect on the thoracic marrow. Observation: A 15-year-old patient was admitted to our institution and complaining of high back pain. Three months before he developed progressive and occasional back pain with thoracic irradiation in hemi-belt, increased by the dorsal decubitus. Neurological examination revealed a spasmodic paraplegia. The muscular strength was quoted as 2 to the left and 3 to the right on a scale of 5. Magnetic resonance imaging (MRI) revealed and extradural cyst located to the dorsal spinal cord. The ablation of a voluminous translucent cyst was achieved after a vast decompressive laminectomy from the sixth to the eighth thoracic vertebra. The dural communication with the cyst was stitched. After surgery, the pain has disappeared and the neurological recovery was progressive over a period of 21 days. The diagnosis of arachnoid cyst was confirmed by histological examination. Conclusion: The extradural thoracic arachnoid cyst is a rare affection of good forecast. In the symptomatic form, the surgery as soon as possible remains the solution. The MRI keeps all its interest for the diagnostic orientation and the therapeutic strategy.

Surgical management of clinoidal meningiomas: 10 cases analysis

Aim: The purpose of this article is to advocate standard skull base technique for removing the clinoidal meningioma and to delineate the technique's advantages that aid in achieving an improved extent of tumor resection and enhancing the patients' overall outcome, specially their visual outcome. Methods: A retrospective analysis was performed on 10 consecutive patients with clinoidal meningiomas who underwent surgical resection at the Bangabandhu Sheikh Mujib Medical University and other private clinics between May 2013 and July 2016. A standard pterional craniotomy technique consisting of extradural anterior clinoidectomy, coupled with optic canal unroofing and optic nerve sheath opening was used in all patients. All patients had thorough preoperative and postoperative ophthalmological evaluations. The follow-up period ranged from 6 to 42 months. Results: Total resection was achieved in 5 (50.0%) of the 10 patients in this series. The majority of the patients with preoperative visual impairment experienced significant visual improvement 7 of 10 patients;70.0%). Conclusion: In the majority of patients with clinoidal meningiomas, total resection may be achieved with minimal complications. For large tumors encasing the optic nerve and internal carotid artery, or for those tumors causing preoperative visual impairment, use of the cranial base technique delineated in this study may lead to significant improvement in the patients' visual and overall outcomes.