Supratentorial subdural hematoma following microvascular decompression
Background: Hemorrhage is the most common during microvascular decompression (MVD) for hemifacial spasm (HFS), trigeminal neuralgia (TN) and glossopharyngeal neuralgia (GN). However, remote supratentorial subdural hematoma is very rare, especially for those patients who reveal severe intraoperative...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-03-01
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| Series: | Interdisciplinary Neurosurgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751921003157 |
| _version_ | 1818459981537607680 |
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| author | Jing Wang Yulong Chong Chengrong Jiang Yuxiang Dai Weibang Liang Lianshu Ding |
| author_facet | Jing Wang Yulong Chong Chengrong Jiang Yuxiang Dai Weibang Liang Lianshu Ding |
| author_sort | Jing Wang |
| collection | DOAJ |
| description | Background: Hemorrhage is the most common during microvascular decompression (MVD) for hemifacial spasm (HFS), trigeminal neuralgia (TN) and glossopharyngeal neuralgia (GN). However, remote supratentorial subdural hematoma is very rare, especially for those patients who reveal severe intraoperative venous bleeding without a definite bleeding source in the suboccipital surgical area, and immediate postoperative computed tomography (CT) reveals supratentorial subdural hematoma. The underlying mechanisms remain obscure. We report 10 cases to discuss the pathophysiology and develop appropriate therapeutic strategies for prevention and treatment. Patients and methods: We retrospectively analyzed clinical data of patients who underwent microvascular decompression in Nanjing Drum Tower Hospital between December 1, 2018 and December 31, 2020. Among 764 patients, bleeding events occurred in 10 cases, whose bleeding origin was not confirmed intraoperatively and immediate postoperative CT revealed supratentorial subdural hematoma. We reviewed characteristics, the intraoperative situations and the prognosis of the 10 cases. Results: The mean age of the patients was 55.4 years; 2 was male and 8 were female. All patients revealed draining large amounts of intraoperative cerebrospinal fluid (CSF) during the operation. Primary unknown cause of severe venous bleeding of 8 patients occurred in different time periods intraoperatively. However, hemorrhage all occurred in a very early stage before decompression. The operation was completed successfully in the 8 patients through the irrigation and drainage of the bloody cerebrospinal fluid. patient Postoperative CT indicated supratentorial acute subdural hematoma (ASDH) with hematoma volume <30 ml. All patients recovered after conservative treatment. Conclusions: Remote supratentorial subdural hematoma is rare, and the acute venous hemorrhage with no origin during MVD always means remote supratentorial subdural hematoma, which is different from traumatic acute subdural hematoma. We suggest that it is important to avoid excessive CSF aspiration. If bleeding occurred in the operative field without origin, we should keep irrigating and removing the bloody CSF, the decompression of responsible arteries can be completed and all the cases could be managed conservatively. |
| first_indexed | 2024-12-14T23:22:59Z |
| format | Article |
| id | doaj.art-48555bc7fc3f44a3a8cfba64d43beaf8 |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-12-14T23:22:59Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-48555bc7fc3f44a3a8cfba64d43beaf82022-12-21T22:43:53ZengElsevierInterdisciplinary Neurosurgery2214-75192022-03-0127101403Supratentorial subdural hematoma following microvascular decompressionJing Wang0Yulong Chong1Chengrong Jiang2Yuxiang Dai3Weibang Liang4Lianshu Ding5Department of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, ChinaDepartment of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, ChinaDepartment of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, ChinaDepartment of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, ChinaDepartment of Neurosurgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, ChinaDepartment of Neurosurgery, The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, China; Corresponding author at: Department of Neurosurgery, The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, 6 West Beijing Road, Huaian, Jiangsu 223001, China.Background: Hemorrhage is the most common during microvascular decompression (MVD) for hemifacial spasm (HFS), trigeminal neuralgia (TN) and glossopharyngeal neuralgia (GN). However, remote supratentorial subdural hematoma is very rare, especially for those patients who reveal severe intraoperative venous bleeding without a definite bleeding source in the suboccipital surgical area, and immediate postoperative computed tomography (CT) reveals supratentorial subdural hematoma. The underlying mechanisms remain obscure. We report 10 cases to discuss the pathophysiology and develop appropriate therapeutic strategies for prevention and treatment. Patients and methods: We retrospectively analyzed clinical data of patients who underwent microvascular decompression in Nanjing Drum Tower Hospital between December 1, 2018 and December 31, 2020. Among 764 patients, bleeding events occurred in 10 cases, whose bleeding origin was not confirmed intraoperatively and immediate postoperative CT revealed supratentorial subdural hematoma. We reviewed characteristics, the intraoperative situations and the prognosis of the 10 cases. Results: The mean age of the patients was 55.4 years; 2 was male and 8 were female. All patients revealed draining large amounts of intraoperative cerebrospinal fluid (CSF) during the operation. Primary unknown cause of severe venous bleeding of 8 patients occurred in different time periods intraoperatively. However, hemorrhage all occurred in a very early stage before decompression. The operation was completed successfully in the 8 patients through the irrigation and drainage of the bloody cerebrospinal fluid. patient Postoperative CT indicated supratentorial acute subdural hematoma (ASDH) with hematoma volume <30 ml. All patients recovered after conservative treatment. Conclusions: Remote supratentorial subdural hematoma is rare, and the acute venous hemorrhage with no origin during MVD always means remote supratentorial subdural hematoma, which is different from traumatic acute subdural hematoma. We suggest that it is important to avoid excessive CSF aspiration. If bleeding occurred in the operative field without origin, we should keep irrigating and removing the bloody CSF, the decompression of responsible arteries can be completed and all the cases could be managed conservatively.http://www.sciencedirect.com/science/article/pii/S2214751921003157Microvascular decompressionAcute subdural hematomaPrognosis |
| spellingShingle | Jing Wang Yulong Chong Chengrong Jiang Yuxiang Dai Weibang Liang Lianshu Ding Supratentorial subdural hematoma following microvascular decompression Interdisciplinary Neurosurgery Microvascular decompression Acute subdural hematoma Prognosis |
| title | Supratentorial subdural hematoma following microvascular decompression |
| title_full | Supratentorial subdural hematoma following microvascular decompression |
| title_fullStr | Supratentorial subdural hematoma following microvascular decompression |
| title_full_unstemmed | Supratentorial subdural hematoma following microvascular decompression |
| title_short | Supratentorial subdural hematoma following microvascular decompression |
| title_sort | supratentorial subdural hematoma following microvascular decompression |
| topic | Microvascular decompression Acute subdural hematoma Prognosis |
| url | http://www.sciencedirect.com/science/article/pii/S2214751921003157 |
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