Neurosurgical Treatment of Patients with Posterior Fossa Acute Subdural Hematoma Right after Cardiac Surgery
As posterior fossa acute subdural hematoma (ASDH) right after cardiac surgery is extremely rare, the clinical course and optimal treatment strategy remain undetermined. We performed a retrospective analysis of patients with posterior fossa ASDH right after cardiac surgery requiring neurosurgical tre...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
The Japan Neurosurgical Society
2022-05-01
|
| Series: | Neurologia Medico-Chirurgica |
| Subjects: | |
| Online Access: | https://www.jstage.jst.go.jp/article/nmc/62/5/62_2021-0314/_pdf/-char/en |
| _version_ | 1818535580709945344 |
|---|---|
| author | Jin KIKUCHI Kimihiko ORITO Kiyohiko SAKATA Masafumi YAMAMOTO Yu HASEGAWA Takahiro SHOJIMA Eiki TAYAMA Motohiro MORIOKA |
| author_facet | Jin KIKUCHI Kimihiko ORITO Kiyohiko SAKATA Masafumi YAMAMOTO Yu HASEGAWA Takahiro SHOJIMA Eiki TAYAMA Motohiro MORIOKA |
| author_sort | Jin KIKUCHI |
| collection | DOAJ |
| description | As posterior fossa acute subdural hematoma (ASDH) right after cardiac surgery is extremely rare, the clinical course and optimal treatment strategy remain undetermined. We performed a retrospective analysis of patients with posterior fossa ASDH right after cardiac surgery requiring neurosurgical treatment at our institution over a 7-year period and, in this study, discussed the neurosurgical strategy and clinical course. Collected data included clinical history, laboratory results, time course, symptoms, neurosurgical treatment, outcome at discharge, and imaging studies. All six patients were women who had no history of head trauma and had received antithrombotic therapy during the perioperative period of cardiac surgery. All patients showed lower platelets count and were diagnosed with ASDH within 3 days (longest time 64 h) right after cardiac surgery. After discontinuation of anticoagulation therapy and administration of reversal agents, they underwent emergency hematoma evacuation craniotomy (n = 5) or burr hole drainage surgery (n = 1), which were performed in the prone (n = 4) or lateral (n = 2) positions. Four of these patients showed favorable outcomes, and two showed poor outcomes. One of the poor-outcome patients received three antithrombotic therapies, and another developed rapidly progressive ASDH. Posterior fossa ASDH associated with antithrombotic therapy right after cardiac surgery is frequently found in women, and emergent neurosurgical treatment with anticoagulation discontinuation and reversal agent administration can be performed safely. Burr hole drainage surgery might be acceptable in nonsevere cases. By contrast, we must pay attention to cases receiving both anticoagulant and antiplatelet drugs and rapid progression cases. |
| first_indexed | 2024-12-11T18:26:48Z |
| format | Article |
| id | doaj.art-66bfb46fc50045cbaa2e830613abcaa7 |
| institution | Directory Open Access Journal |
| issn | 1349-8029 |
| language | English |
| last_indexed | 2024-12-11T18:26:48Z |
| publishDate | 2022-05-01 |
| publisher | The Japan Neurosurgical Society |
| record_format | Article |
| series | Neurologia Medico-Chirurgica |
| spelling | doaj.art-66bfb46fc50045cbaa2e830613abcaa72022-12-22T00:55:02ZengThe Japan Neurosurgical SocietyNeurologia Medico-Chirurgica1349-80292022-05-0162523824510.2176/jns-nmc.2021-03142021-0314Neurosurgical Treatment of Patients with Posterior Fossa Acute Subdural Hematoma Right after Cardiac SurgeryJin KIKUCHI0Kimihiko ORITO1Kiyohiko SAKATA2Masafumi YAMAMOTO3Yu HASEGAWA4Takahiro SHOJIMA5Eiki TAYAMA6Motohiro MORIOKA7Department of Neurosurgery, Kurume University School of MedicineDepartment of Neurosurgery, Kurume University School of MedicineDepartment of Neurosurgery, Kurume University School of MedicineDepartment of Neurosurgery, Kurume University School of MedicineDepartment of Neurosurgery, Kurume University School of MedicineDivision of Cardiovascular Surgery, Department of Surgery, Kurume University School of MedicineDivision of Cardiovascular Surgery, Department of Surgery, Kurume University School of MedicineDepartment of Neurosurgery, Kurume University School of MedicineAs posterior fossa acute subdural hematoma (ASDH) right after cardiac surgery is extremely rare, the clinical course and optimal treatment strategy remain undetermined. We performed a retrospective analysis of patients with posterior fossa ASDH right after cardiac surgery requiring neurosurgical treatment at our institution over a 7-year period and, in this study, discussed the neurosurgical strategy and clinical course. Collected data included clinical history, laboratory results, time course, symptoms, neurosurgical treatment, outcome at discharge, and imaging studies. All six patients were women who had no history of head trauma and had received antithrombotic therapy during the perioperative period of cardiac surgery. All patients showed lower platelets count and were diagnosed with ASDH within 3 days (longest time 64 h) right after cardiac surgery. After discontinuation of anticoagulation therapy and administration of reversal agents, they underwent emergency hematoma evacuation craniotomy (n = 5) or burr hole drainage surgery (n = 1), which were performed in the prone (n = 4) or lateral (n = 2) positions. Four of these patients showed favorable outcomes, and two showed poor outcomes. One of the poor-outcome patients received three antithrombotic therapies, and another developed rapidly progressive ASDH. Posterior fossa ASDH associated with antithrombotic therapy right after cardiac surgery is frequently found in women, and emergent neurosurgical treatment with anticoagulation discontinuation and reversal agent administration can be performed safely. Burr hole drainage surgery might be acceptable in nonsevere cases. By contrast, we must pay attention to cases receiving both anticoagulant and antiplatelet drugs and rapid progression cases.https://www.jstage.jst.go.jp/article/nmc/62/5/62_2021-0314/_pdf/-char/enacute subdural hematomaantithrombotic therapycardiac surgeryposterior fossareversal agent |
| spellingShingle | Jin KIKUCHI Kimihiko ORITO Kiyohiko SAKATA Masafumi YAMAMOTO Yu HASEGAWA Takahiro SHOJIMA Eiki TAYAMA Motohiro MORIOKA Neurosurgical Treatment of Patients with Posterior Fossa Acute Subdural Hematoma Right after Cardiac Surgery Neurologia Medico-Chirurgica acute subdural hematoma antithrombotic therapy cardiac surgery posterior fossa reversal agent |
| title | Neurosurgical Treatment of Patients with Posterior Fossa Acute Subdural Hematoma Right after Cardiac Surgery |
| title_full | Neurosurgical Treatment of Patients with Posterior Fossa Acute Subdural Hematoma Right after Cardiac Surgery |
| title_fullStr | Neurosurgical Treatment of Patients with Posterior Fossa Acute Subdural Hematoma Right after Cardiac Surgery |
| title_full_unstemmed | Neurosurgical Treatment of Patients with Posterior Fossa Acute Subdural Hematoma Right after Cardiac Surgery |
| title_short | Neurosurgical Treatment of Patients with Posterior Fossa Acute Subdural Hematoma Right after Cardiac Surgery |
| title_sort | neurosurgical treatment of patients with posterior fossa acute subdural hematoma right after cardiac surgery |
| topic | acute subdural hematoma antithrombotic therapy cardiac surgery posterior fossa reversal agent |
| url | https://www.jstage.jst.go.jp/article/nmc/62/5/62_2021-0314/_pdf/-char/en |
| work_keys_str_mv | AT jinkikuchi neurosurgicaltreatmentofpatientswithposteriorfossaacutesubduralhematomarightaftercardiacsurgery AT kimihikoorito neurosurgicaltreatmentofpatientswithposteriorfossaacutesubduralhematomarightaftercardiacsurgery AT kiyohikosakata neurosurgicaltreatmentofpatientswithposteriorfossaacutesubduralhematomarightaftercardiacsurgery AT masafumiyamamoto neurosurgicaltreatmentofpatientswithposteriorfossaacutesubduralhematomarightaftercardiacsurgery AT yuhasegawa neurosurgicaltreatmentofpatientswithposteriorfossaacutesubduralhematomarightaftercardiacsurgery AT takahiroshojima neurosurgicaltreatmentofpatientswithposteriorfossaacutesubduralhematomarightaftercardiacsurgery AT eikitayama neurosurgicaltreatmentofpatientswithposteriorfossaacutesubduralhematomarightaftercardiacsurgery AT motohiromorioka neurosurgicaltreatmentofpatientswithposteriorfossaacutesubduralhematomarightaftercardiacsurgery |