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1
Tonga, Faruk, and Özgür Demir. "Comparison of One Burr Hole and Two Burr Hole Techniques in the Surgical Treatment of Chronic Subdural Hematomas." Chronicles of Precision Medical Researchers 3, no. 3 (2022): 102–6. https://doi.org/10.5281/zenodo.7193041.
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Objective: To compare one or two burr hole techniques in our operated patients with Chronic Subdural Hematoma (CSDH). Materials and methods: Between January 2013 and December 2021, 104 operations were performed on 84 patients, 62 of which were in one burr hole and 42 were in two burr holes. Data were obtained retrospectively from patient records. Statistical analysis was done with SPSS 25.0 program. Results: Of the 84 patients, 20 (23.8%) were female and 64 (76.2%) was male. Of 104 operations, 27 (26%) were performed on female patients and 77 (74%) on male patients. The mean age is 72.63 (20-96). Among 104 operations, 52 (50%) hypertension (HT), 39 (37.5%) diabetus mellitus (DM), 16 (15.4%) cardiac failure (CF), 7 (6.7%) choronic renal failure (CRF), 2 (1.9%) coagulopathy, 33 (31%) ,7) had dementia, 38 (36.5%) antiplatelet or anticoagulant use, 20 (19.2%) smoking, 11 (10.6%) alcohol addiction, 65 (62.5%) head trauma. Operation time and postoperative hospital stay were 31.6 minutes in a burr hole, respectively. and 7.3 days, 60 minutes in two burr holes. and it was 7 days. Recurrence developed in 3 patients, 2 of whom had CRF. Two of them were two burr holes and one was a hole operation. There was no significant difference in the comparison of one burr hole and two burr hole data, except for the operation time. The effectiveness of risk factors on the development of recurrence was significant only for CRF. Conclusion: One burr hole operation is as effective and safe as two burr holes in the surgical treatment of chronic subdural hematoma. We recommend a burr hole as the operation time is shorter
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Liebelt, Brandon D., Fangxiang Chen, Antonio Biroli, Xiaochun Zhao, and Peter Nakaji. "One- vs Two-Burr-Hole Technique for Combined Endoscopic Third Ventriculostomy and Pineal Region Biopsy: Volumetric Analysis of Brain at Risk." Operative Neurosurgery 19, no. 2 (2020): 175–80. http://dx.doi.org/10.1093/ons/opaa010.
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Abstract BACKGROUND Pineal region tumors are associated with the ventricular system. Endoscopic third ventriculostomy (ETV) is often performed at the same time as tumor biopsy. OBJECTIVE To investigate the volume of brain possibly undergoing injury and forniceal stretching during ETV and tumor biopsy. METHODS We performed a retrospective review of preoperative magnetic resonance imagings (MRIs) and computed tomography (CTs) of patients with pineal region masses and used volumetric image-guided navigation to simulate a 1-burr-hole vs a 2-burr-hole approach through the brain parenchyma. We compared the volumes of parenchyma and fornix at the risk of injury. RESULTS The ideal entry point for ETV using 2 burr holes was a mean ± standard deviation (SD) of 25.8 ± 6 mm from the midline and 11.4 ± 9 mm behind the coronal suture. The ideal entry point using 2 burr holes for tumor biopsy was 25.7 ± 8 mm from the midline and 53.7 ± 14 mm anterior to the coronal suture. With 1 burr hole, the mean ± SD volume of brain parenchyma at risk was 852 ± 440 mm3. The volume of brain parenchyma at risk with 2 burr holes was 2159 ± 474 mm3 (P < .001; paired t-test). The use of 1 burr hole predisposed the fornix to 14 ± 3 mm of possible stretch, which was minimized with the 2-burr-hole approach. CONCLUSION Using 1 burr hole for both the ETV and tumor biopsy is less likely to traumatize the brain parenchyma than using 2 burr holes. However, 1 burr hole predisposes the fornix to stretch injury. We recommend tailoring the entry to each patient according to their anatomy rather than using a 1-size-fits-all approach.
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Rai, Survendra Kumar Rajdeo, Saswat Kumar Dandpat, Dikpal Jadhav, Shashi Ranjan, Abhidha Shah, and Atul H. Goel. "Optimizing Burr Hole Placement for Craniotomy: A Technical Note." Journal of Neurosciences in Rural Practice 10, no. 03 (2019): 413–16. http://dx.doi.org/10.1055/s-0039-1695699.
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Abstract Objective Usually, burr holes are placed along the line of a craniotomy. We describe a novel technique of burr hole placement to obtain smooth and beveled bony margin without any troughs and crests. Dural separation is obtained by minimizing the number of burr holes required. Methods Fifty craniotomies of diameter ranging from 3.5 to 11.5 cm were accomplished by placing burr hole in the center of bone flap rather than along the craniotomy line permitting 360 degrees of dura separation dependent on the length of dura separator. Craniotomy < 9 cm in diameter was performed by placing a single burr hole and a larger size craniotomy was performed with two burr holes. Parasagittal craniotomy was performedby placing burr hole not > 2.5 cm away from expected craniotomy site, namely superior sagittal sinus area enabling separation of adhered dura and venous sinuses. The bone cutter was used in a particular fashion to create smooth margin and beveled edges. Results Craniotomy < 9 cm in diameter was possible with single burr hole in 34 cases. Craniotomy larger than 9 cm in size was performed in 16 cases with double burr hole by strategically placing burr in the center of the desired bone flap. The craniotomy was achieved in all cases without damaging dura and venous structures. Conclusions An optimally placed single burr hole is sufficient for small to moderately large size craniotomy. Larger size craniotomy is possible with minimum numbers of burr holes. This achieves good cosmesis and avoids sinking of the bone flap.
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Heringer, Lindolfo Carlos, Ulysses de Oliveira Sousa, Matheus Fernandes de Oliveira, et al. "The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas." Arquivos de Neuro-Psiquiatria 75, no. 11 (2017): 809–12. http://dx.doi.org/10.1590/0004-282x20170136.
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ABSTRACT Burr hole evacuation has been the most frequently-used procedure for the treatment of chronic subdural hematomas (CSDH). Objective: To evaluate whether the use of a drain and/or the number of burr holes for treatment of CSDH modifies the rates of recurrence and complications. Methods: A retrospective review of 142 patients operated on because of CSDH, between 2006 and 2015, analyzing recurrence and complications of the use of one or two burr holes with or without the use of a drain. Results: Thirty-seven patients had bilateral CSDH (26%) and 105 (73.9%) patients had unilateral CSDH. Twenty-two (59.4%) patients were given a drain and 15 (40.6%) were not. A total number of recurrences occurred in 22 (15.5%) patients and the total number of complications was in six (4.2%) patients. Mean follow-up time was 7.67 months. Conclusions: The number of burr holes and the use of the drain did not alter the rates of recurrence and complications in the treatment of CSDH.
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Wang, Xiang, Xiao Hu Zheng, Qing Long An, and Ming Chen. "Experimental Investigation on Drilling PCB Through-Holes." Advanced Materials Research 426 (January 2012): 56–59. http://dx.doi.org/10.4028/www.scientific.net/amr.426.56.
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More and more attention is put on the machinability of printed circuit board (PCB) with the increasing demand of PCBs driven by the strong need of the market of the electronic products. In this paper, drill wear and burr size, as two main objects of experimental investigation, have been observed and analyzed in drilling PCB through-holes. The results of the drilling experiment conducted with normal drill and specialized drill, indicate that appropriate chisel edge thinning is in favor of decreasing flank wear of the drill, but has no apparent effect on reducing burr size for PCB through-holes drilling.
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Kawaguchi, Tetsuro, Shigekiyo Fujita, Kohkichi Hosoda, et al. "Multiple burr-hole operation for adult moyamoya disease." Journal of Neurosurgery 84, no. 3 (1996): 468–76. http://dx.doi.org/10.3171/jns.1996.84.3.0468.
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✓ Excellent results from multiple burr-hole operations for adult moyamoya disease are reported in this study. Ten patients had between one and four burr holes (mean 2.1) drilled in each hemisphere. In four patients new burr holes were added on the opposite side after depression of cerebral blood flow (CBF) was detected by follow-up single-photon emission computerized tomography imaging of the brain with N-isopropyl-p-[123I]iodoamphetamine. The postoperative follow-up period ranged from 6 to 62 months (mean 34.7 months). Beginning at 6 months postsurgery, angiograms disclosed rich neovascularization at 41 of 43 burr holes, first from the middle meningeal artery, then from the superficial temporal artery. Neovascularization did not occur at two burr holes at which there was subdural effusion and local cerebral atrophy, respectively. Progression of stenosis of the major vessels was seen in six patients. Moyamoya vessels were decreased at six sites in four patients. The CBF study revealed that the reactivity to acetazolamide improved in all six patients tested. Transient ischemic attacks disappeared in all six patients presenting with this symptom, and preoperative symptoms improved in both of the patients who presented with cerebral infarction and in both patients with intraventricular hemorrhage. There was no mortality or morbidity, and no new neurological deficits or rebleeding developed during the follow-up period. The authors strongly recommend the multiple burr-hole operation as the surgical treatment of choice for adult moyamoya disease because of its safety and effectiveness.
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Dusick, Joshua R., Nestor R. Gonzalez, and Neil A. Martin. "Clinical and Angiographic Outcomes From Indirect Revascularization Surgery for Moyamoya Disease in Adults and Children: A Review of 63 Procedures." Neurosurgery 68, no. 1 (2011): 34–43. http://dx.doi.org/10.1227/neu.0b013e3181fc5ec2.
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Abstract BACKGROUND: Several forms of indirect cerebral revascularization have been proposed to promote neovascularity to the ischemic brain. OBJECTIVE: To present clinical and angiographic outcomes of indirect revascularization by encephaloduroarteriosynangiosis and burr holes for the treatment of Moyamoya disease in adults and children. METHODS: Data from 63 hemispheres treated in 42 patients (average age, 30 years; 33 adults; 30 female patients; median follow-up, 14 months) were reviewed. In hemispheres with preoperative and postoperative (6- to 12-month) angiograms available, superficial temporal artery (STA) and middle meningeal artery (MMA) diameters were measured. Preoperative and postoperative corrected arterial sizes were compared. RESULTS: Seven patients (17%) had transient ischemic attacks that resolved within 1 month of surgery. No patients suffered moyamoya-related hemorrhage after treatment. Two patients developed additional symptoms many years after surgery. In 18 hemispheres with preoperative and postoperative angiograms, there was an average postoperative increase in STA and MMA diameters of 51% (P = .003) and 49% (P = .002), respectively. Both children and adults displayed revascularization. Two patients did not demonstrate increased vessel size. STA blush and new branches and MMA blush and new branches were identified in 12, 14, 14, and 16 hemispheres, respectively. Angiographic blush was identified in 59% of frontal and 19% of parietal burr holes (P = .03). Surgical complications included 2 subdural hemorrhages requiring evacuation and 2 new ischemic deficits (1 transient). CONCLUSION: Indirect revascularization by encephaloduroarteriosynangiosis and burr holes for moyamoya results in long-term resolution of ischemic and hemorrhagic manifestations in 95% of adults and children. The MMA appears to contribute significantly to the revascularization on follow-up angiograms with increased size and neovascularity comparable to that of the STA. Angiographically, parietal burr holes do not contribute as significantly as frontal burr holes.
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Giorleo, Luca. "Poly(methyl methacrylate) Coating of Titanium Workpieces to Reduce Burrs in Micro-drilling." Micromachines 10, no. 12 (2019): 838. http://dx.doi.org/10.3390/mi10120838.
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A technique to reduce burr height in titanium micro-drilling is presented: a poly (methyl methacrylate) coating was applied before machining on the upper and lower surfaces of a titanium specimen (0.5-mm thick). After drilling, a cleaning process (acetone bath) was executed to eliminate the coating, and holes with less burr were obtained. The coating process was executed with a spin-coating machine. To test the efficacy of the technique, two different coating thicknesses (7.9 and 5.4 μm) and two drill bits (0.25- and 0.5-mm diameter) were evaluated. Qualitative and quantitative analyses of the holes obtained were performed with scanning electron microscopy and three-dimensional microscopy, respectively. The results highlight the efficacy of the technique to reduce the burr height by 70% in coated titanium relative to that in an uncoated titanium sheet.
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Sauer, Norman J., and Samuel Strong Dunlap. "The Assymetrical Remodelling of Two Neurosurgical Burr Holes: A Case Study." Journal of Forensic Sciences 30, no. 3 (1985): 11032J. http://dx.doi.org/10.1520/jfs11032j.
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Pizzi, Margherita, Francesco De Gaetano, Marco Ferroni, Federica Boschetti, and Massimiliano Annoni. "A Deep-Hole Microdrilling Study of Pure Magnesium for Biomedical Applications." Micromachines 14, no. 1 (2023): 132. http://dx.doi.org/10.3390/mi14010132.
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The mechanisms of deep-hole microdrilling of pure Mg material were experimentally studied in order to find a suitable setup for a novel intraocular drug delivery device prototyping. Microdrilling tests were performed with 0.20 mm and 0.35 mm microdrills, using a full factorial design in which cutting speed vc and feed fz were varied over two levels. In a preliminary phase, the chip shape was evaluated for low feeds per tooth down to 1 μm, to verify that the chosen parameters were appropriate for machining. Subsequently, microdrilling experiments were carried out, in which diameter, burr height and surface roughness of the drilled holes were examined. The results showed that the burr height is not uniform along the circumference of the holes. In particular, the maximum burr height increases with higher cutting speed, due to the thermal effect that plasticizes Mg. Hole entrance diameters are larger than the nominal tool diameters due to tool runout, and their values are higher for high vc and fz. In addition, the roughness of the inner surface of the holes increases as fz increases.
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Seçer, Halil İbrahim, Bülent Düz, Alparslan Kırık, İlker Solmaz, Yusuf İzci, and Engin Gönül. "Chronic Subdural Hematoma Treated By Two Burr-Hole Craniostomy And Closed-System Drainage In Elderly Patients." Sinir Sistemi Cerrahisi Dergisi 1, no. 4 (2008): 220–28. https://doi.org/10.54306/sscd.2008.8.
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Objective: This retrospective study of the records of 45 patients over than 60s years with chronic subdural hematoma treated with two burr-holes craniostomy with closed-system drainage was carried out. Methods: Between 1995 and 2007 at Gulhane Military Medical Academy, Neurosurgery Department, 45 consecutive patients over than 60s years treated with two burr-holes craniostomy with closed-system drainage for chronic subdural hematoma were evaluated for etiology, preoperative and postoperative early follow-up symptoms and signs, Karnofsky performance score, computerized tomography (CT) scan results, and complications. Results: The series included 32 males and 13 females, mean age 76,3 years. The principal symptom was altered mental status, gait disturbance, and headache. 11 patients had no etiological factors. Karnofsky performance score was 64,89 preoperatively, and 70,67 postoperatively. The mean thickness of the hematoma was 2,14 cm preoperatively, and 0,9 cm postoperatively. No complications occurred due to surgery. 6 patients died in hospital due to systemic complications. We performed the second operation in 8 cases. Conclusion: Burr-hole with a closed drainage system is a simple, safe and efficient method for the treatment of CSDHs with a low rate of complications. In our experience, the worst prognostic factors for the outcome of CSDH patients were the neurological conditions and additional systemic diseases at the time of surgery.
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Agrawal, Yogesh, Ashok Gupta, and Virendra Sinha. "Chronic Subdural Hematoma Surgical Evacuation with Burr-Hole Drainage: An Institutional Experience." Indian Journal of Neurotrauma 14, no. 02/03 (2017): 059–64. http://dx.doi.org/10.1055/s-0037-1606210.
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Abstract Background Chronic SDH (CSDH) is one of the most common clinical entities in neurosurgery with most favorable prognosis commonly encountered in elderly patients with history of minor trauma and surgery is gold standard treatment. Objectives This study was done to evaluate the clinical presentation, radiologic findings, complications, and management of patients with CSDH who were treated surgically with burr-hole evacuation. Materials and Methods This prospective study was done in Department of Neuro-surgery, SMS Medical College, Jaipur, India, from September 2015 to April 2016. The sample size was 55. Results In this study out of 55 patients, 39 (71%) patients were male and 16 (29%) were female. The most common age group in which CSDH observed was between 61 and 70 years. Most common presenting symptom was headache present in 30 (54.55%) patients followed by weakness. Midline shift more than 5 mm was seen in 43 (78%) patients. The most common complication was recurrence of CSDH (5.4%) in our study. Recurrence after single burr hole was 16.6% and 4.1% after double burr holes. Simple pneumocephalus was present in almost all cases and tension pneumocephalus was found in one (1.8%) patient. Conclusion Complete evacuation of unilateral CSDH by two burr holes at highest point of hematoma is sufficient. Factors affecting recurrence rate include old age, gross midline shift, and single burr hole. Postoperative simple pneumocephalus is a common radiologic finding that requires no treatment and it does not affect ultimate outcome. Tension pneumocephalus is a serious complication requiring emergent treatment.
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Baykal, Duygu, and Elif Başaran Gündoğdu. "Comparison of the Results of Different Surgical Techniques in the Treatment of Chronic Subdural Hematoma in a Training and Research Hospital." Archives of Current Medical Research 5, no. 3 (2024): 105–10. http://dx.doi.org/10.47482/acmr.1517555.
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Background: Chronic subdural hematoma can cause compression of brain tissue followed by neurological deficits. There are several methods for the treatment of chronic subdural hematoma, but the most appropriate treatment is still controversial. we compared 5 different surgical methods applied by five different surgeons in a single center and we suggest the most appropriate treatment method in the literature. Methods: In this study, the files of patients diagnosed with chronic subdural hematoma who underwent surgery at the Neurosurgery Clinic of S.B.U. Bursa City Hospital were retrospectively examined. The patients were evaluated in terms of their complaints, neurological examinations, type of operation, use of subdural drain and postoperative complications. Five different surgical techniques were applied to the patients. Results: We collected data from 185 patients who underwent surgery due to chronic subdural hematoma. Different surgical techniques were used in the treatment of patients. Only one burr hole was opened in 22 of the patients, one burr hole was opened in 40 of them and 1 drain was placed in the subdural space, only two burr holes were opened in 41 of them, two burr holes were opened in 58 of them and 1 drain was placed in the subdural space, and mini craniotomy was performed in 24 patients. Conclusion: Five different surgical methods used in the treatment of chronic subdural hematoma have advantages and disadvantages. We believe that a study conducted by increasing the number of patients, ensuring homogenization of groups, and increasing surgical techniques will shed light on the literature.
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Kim, Kwang-Joon, Young-Gwan Kim, and Kwon-Hee Kim. "Characterization of Deburring by Abrasive Flow Machining for AL6061." Applied Sciences 12, no. 4 (2022): 2048. http://dx.doi.org/10.3390/app12042048.
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Burrs form due to the plastic deformation of materials during machining processes, such as milling and drilling. Deburring can be very difficult when the burrs are not easily accessible for removal. In this study, abrasive flow machining (AFM) was adopted for deburring the edges of milling specimens. Based on the experimental observations on AL6061 specimens, the deburring performance was characterized in terms of flow speed, the local curvature of the streamline near the burr edge, and shear stress. A new objective function that can predict the extent of deburring is proposed based on these characteristics and validated through milling burr edge erosion tests by abrasive flow. Based on the assumption that the flow component is tangential to the burr edge has relatively little contribution to the edge erosion, an attempt was made for the application of the new objective function to the three-dimensional burr edge formed by two intersecting holes drilled with offset. The deburring test results and predictions from three-dimensional computational fluid dynamics’ (CFD) simulations were in reasonable agreement.
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Yadav, Vikrant, and Nityanand Pandey. "Quartet of catastrophe: Bilateral epidural hematoma in both supratentorial and infratentorial compartments – A case report and a novel surgical technique to approach." Surgical Neurology International 14 (October 13, 2023): 369. http://dx.doi.org/10.25259/sni_515_2023.
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Background: Epidural hematoma (EDH) is the most common form of traumatic brain lesion in the posterior fossa. This condition is rapidly fatal if not identified and treated accordingly, due to the proximity of the brain stem. Prompt diagnosis is made by early computed tomography (CT) of the head and emergent evacuation is of utmost importance. Case Description: A 28-year-old male presented to the emergency room with complaints of headache and vomiting following a road traffic accident. CT scan revealed EDH around the transverse sinus extending into supratentorial and infratentorial compartment bilaterally. The patient was planned for emergency surgery but relatives did not give consent initially they agreed after 24 h when the patient became unconscious. A midline incision was made and a small infratentorial craniectomy with two burr holes was made bilaterally above the transverse sinus. Excellent recovery was seen following a surgical procedure. Conclusion: Posterior fossa EDH is a rare but potentially fatal entity. Bilateral extension in supratentorial and infratentorial compartments makes it a “quartet of catastrophe.” Prompt diagnosis and emergent evacuation lead to excellent recovery. Two burr holes in supratentorial compartments and a small infratentorial craniectomy can avoid sinus injury.
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Wackym, P. A., R. F. Canalis, and T. Feuerman. "Subdural empyema of otorhinological origin." Journal of Laryngology & Otology 104, no. 2 (1990): 118–22. http://dx.doi.org/10.1017/s0022215100112010.
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AbstractThe UCLA experience with subdural empyema (SDE) of otorhinological origin was reviewed. All cases of SDE with additional intracranial complications were excluded. Thirteen cases of SDE were identified with the prediposing factors being sinusitis (ten), mastoiditis (two), and otitis media (one). Based on data obtained from this review and from studies previously published in the literature, the keys to optimal outcome are rapid diagnosis, craniotomy with complete evacuation of the purulent collection followed by immediate surgical management of the otorhinological source of the SDE, and appropriate antibiotic therapy. Computed tomography is nearly always diagnostic but can be equivocal and magnetic resonance imaging may become the diagnostic study of choice. Of the five patients initially treated with craniotomy, 100 per cent improved as compared to 50 per cent of the eight patients initially treated with burr holes. None of the patients initially managed with craniotomy were worse or died, whereas of the four patients initially managed with burr holes, two were worse (25 per cent) and two died (25 per cent). Antibiotic therapy is guided by the organisms found in the empyema and the site of origin of the infection. The otolaryngologist must remain aware of the clinical features and management of SDE and work closely with his neurosurgical colleagues to provide early, decisive surgical treatment.
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Gökay Korkmaz, Habip, Serkan Toros, Mehmet Halkaci, and Hüseyin Selçuk Halkaci. "Investigation of Hydro-piercing Method for Stainless Steels by Finite Element Method." MATEC Web of Conferences 220 (2018): 01003. http://dx.doi.org/10.1051/matecconf/201822001003.
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Researches and studies on hydroforming process, which is a method that is getting more and more popular every day thanks to its many advantages in application, are ongoing. It is possible to pierce- the holes on a tube or sheet hydroformed part using hydropiercing method after the forming operation. In this study, hydropiercing process of a 304 stainless steel is simulated via the LS-Dyna in 2D axial symmetry model. In the simulations two types of punch movement was investigated to determine the contribution to the burr formation. In the simulations, Jonson-Cook hardening and damage model were used to determine the initiation of the crack on the samples. As a result, the burr formation can be eliminated by the two step movement of the punch through the piercing operation.
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Endo, Masataka, Nobuyuki Kawano, Yoshio Miyasaka, and Kenzoh Yada. "Cranial burr hole for revascularization in moyamoya disease." Journal of Neurosurgery 71, no. 2 (1989): 180–85. http://dx.doi.org/10.3171/jns.1989.71.2.0180.
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✓ Currently, superficial temporal artery-middle cerebral artery (MCA) anastomosis, encephalomyosynangiosis (EMS), and encephalo-duro-arterio-synangiosis are used to treat moyamoya disease and are reported to effectively improve ischemic symptoms. All are methods of reversing the flow of blood from the external carotid artery system into the cortical branches of the MCA. As moyamoya disease advances, these operations alone will predictably not correct the deterioration in blood flow in the territory of the anterior cerebral artery. It was noted in a case of moyamoya disease with intraventricular hemorrhage that a burr hole, made in the frontal region for drainage purposes, induced marked neovascularization. Since then, similar frontal burr holes have been made in five juvenile cases of moyamoya disease; this procedure involved making a burr hole in both frontal bones and incising both the dura and the arachnoid membrane. In two cases a frontal burr hole was placed simultaneously with EMS, and in the others the frontal burr hole was made following EMS. The clinical symptoms improved after the frontal burr hole was made, and dynamic computerized tomography revealed improved circulation in the frontal regions. Together with conventional surgical therapy for juvenile cases of moyamoya disease, this operation is considered beneficial both to the circulation in the frontal region and for the protection of frontal brain function.
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Yrysov, K. B., A. Zh Seideldaev, Zh T. Tashibekov, and A. A. Kanyev. "Comparative analysis of the results of surgical treatment of chronic subdural hematomas by craniotomy and burr hole surgery." Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery), no. 9 (September 20, 2023): 718–24. http://dx.doi.org/10.33920/med-01-2309-04.
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A chronic subdural hematoma is a disease of the elderly. The analysis of a series of more than 200 surgical interventions for chronic subdural hematoma over a 5‑year period is presented. The clinical picture and neurosurgical treatment are considered with a special emphasis on the surgical technique. Material and methods. In the period from 2017 to 2022, a retrospective analysis of 120 patients (74 men and 46 women, with a mean age of 77.4 years [ranging from 24 to 89 years]) suffering from chronic subdural hematoma was performed. Results. 88 craniotomies and 32 burr holes were performed. Forty-two patients after craniotomy (28 %) required surgical revision, in contrast to 6 patients after burr hole surgery (14 %). Craniectomy was performed as a last resort after at least 3 previous evacuations. Conclusion. Craniotomy seems to have a higher chronic subdural hematoma recurrence rate; therefore, burr hole surgery should be a preferable technique. Craniectomy may be a good therapy option for complicated recurrent chronic subdural hematomas.
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Pathoumthong, Kolakoth, and Chumpon Jetjumnong. "Comparative study of subdural drain (SDD) versus sub periosteal drain (SPD) in treating patient with chronic subdural hematoma (CSDH)." Surgical Neurology International 12 (August 24, 2021): 421. http://dx.doi.org/10.25259/sni_592_2021.
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Background: Chronic subdural hematoma (CSDH) is common neurosurgical condition encountered in daily practice. Burr holes evacuation is standard treatment for symptomatic cases. Both subdural drain (SDD) and subperiosteal drain (SPD) have been reported to lower the recurrence rate when used in conjunction with burr holes. A randomized controlled trials were done to see if there were any differences in clinical and radiographic outcomes between the two types of drains. Methods: A total of 42 CSDH patients were enrolled and allocated to one of two groups: SDD (n = 21) or SPD (n = 21). Demographic data, perioperative imaging characteristics, clinical outcome, and recurrence rate were recorded for comparison. Results: In both groups, demographic characteristics such as sex ratio, mean age of patients, concomitant disease, and antithrombotic agent use were similar. At 6 months, 20 (95.2%) and 21 (100%) cases in the SDD and SPD groups, respectively, had a favorable outcome (mRS 0–3). Complete hematoma resolution at 6 months was achieved in 21 (100%) and 19 (90.5%) cases of the SDD and SPD groups, respectively. The amount of drain within 48 h was not difference between the two groups. None of the SDD recurred, but two of the SPD group did, necessitating reoperation, which had no effect on the final outcome. Conclusion: These findings indicate that the drain type (SDD or SPD) has no effect on the outcome. The surgeon’s preference determines which procedure is used. Except in symptomatic circumstances, routine postoperative imaging may not be required.
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Ye, Vincent C. "Burr holes, bone flaps, and goose quills: Dr Frank Turnbull, Vancouver’s first neurosurgeon." Journal of Medical Biography 28, no. 1 (2017): 58–63. http://dx.doi.org/10.1177/0967772017729562.
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Dr Frank Turnbull was a pioneer neurosurgeon – the first neurosurgeon in Vancouver, Canada. He started his practice in 1933 after spending time during a neurosurgical ‘residency’ with Dr Kenneth Mackenzie, Canada’s first neurosurgeon. Dr Turnbull practiced at a time when the perception of his speciality was dim, and the resources available to him were limited. However, Dr Turnbull overcame these obstacles, and two World Wars to help change the landscape of neurosurgery in the northwest Canada, and his career achievements also extend into medical politics and medical education. This paper documents the life and adventures of Dr Frank Turnbull, pioneer neurosurgeon.
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Meguro, Kotoo, Eiki Kobayashi, and Yutaka Maki. "Acute Brain Swelling during Evacuation of Subdural Hematoma Caused by Delayed Contralateral Extradural Hematoma: Report of Two Cases." Neurosurgery 20, no. 2 (1987): 326–28. http://dx.doi.org/10.1227/00006123-198702000-00023.
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Abstract Two patients experienced severe brain swelling during the evacuation of acute subdural hematomas. Postoperative computed tomographic (CT) scans revealed delayed extradural hematomas on the sides opposite the subdural hematomas. Extradural bleeding occurred in the area of the fractured skull. One patient improved neurologically after evacuation of the extradural hematoma, and the other was not operated because he was moribund. Drilling exploratory burr holes in the fractured area may have been a better strategy than awaiting a postoperative CT scan. The reduction of intracranial pressure after the removal of subdural hematoma was postulated to be the most important factor contributing to the formation of the extradural hematoma.
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Edo, Suryopratomo1. "INVESTIGATION OF HOLE QUALITY AND TOOL WEAR IN HIGH-SPEED DRILLING OF AL 7050." Mechanical Engineering: An International Journal (MEIJ), 04, no. 1/2/3/4 (2023): 10. https://doi.org/10.5281/zenodo.7741244.
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This paper investigated the feasibility of drilling aluminum 7050 with enhanced cutting speed. Two identical tools and two identical Al-7050 work-piece plates were utilised during the experiment. Wet cooling drilling on both conventional and high cutting speeds was conducted to compare the results. A total of 338 holes were drilled towards the end of the experiment. Tests for tool wear, borehole diameter, and hole quality were carried out to observe the different drilling performances by drilling with different cutting speeds. The result shows that the proposed high speed drilling produced better diameter accuracy, better surface roughness but poor exit burr hole tendency.
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Shi, Wentian, Tianming Yan, Yude Liu, et al. "Simulation Analysis and Experimental Study on SLM Forming Titanium Alloy Milling Hole." Metals 12, no. 11 (2022): 1919. http://dx.doi.org/10.3390/met12111919.
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Using finite element analysis software and based on the Johnson–Cook failure criterion, a 3D printing workspace model with collapse, powder sticking, and cavity defects was established under the selective laser melting (SLM) forming process. The simulation analysis of milling holes was carried out, and the relationship between cutting speed and material-removal rate on tool wear and entrance burr was derived. The hole-milling experiment was carried out to verify the dimensional accuracy and surface appearance of the hole under the two processes of SLM direct forming and re-milling after forming; the inhibition effect of re-milling after forming on collapse, powder sticking, and cavity defects in hole forming were studied, and the formation mechanism of various defects such as burrs, scratches, and hole-wall cracks in the hole-milling process was analyzed. The Kistler9129A dynamometer was used to measure the cutting forces of re-milling holes and direct milling holes, and a comparative analysis was carried out. The influence of cutting speed, hole diameter, and material-removal rate on the axial force of milling holes was explored. The experiment results were consistent with the simulation cutting model, and the model’s accuracy was verified.
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Vemula, Ramesh Chandra, B. C. M. Prasad, Venkat Koyalmantham, and Kunal Kumar. "Trephine Craniotomy versus Burr Hole Drainage for Chronic Subdural Hematoma—An Institutional Analysis of 156 Patients." Indian Journal of Neurotrauma 17, no. 02 (2020): 110–20. http://dx.doi.org/10.1055/s-0040-1713461.
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Abstract Introduction Some neurosurgeons believe that doing a trephine craniotomy (TC) decreases the chance of recurrence in chronic subdural hematoma (cSDH). But this is not supported by any evidence. Methods A retrospective analysis of patients who were operated for cSDH from 2014 to 2019 at our institute was done. Factors causing recurrence were studied. Results A total of 156 patients were operated in the given period, among which 88 underwent TC and 68 patients underwent burr hole drainage (BHD) for evacuation of cSDH. All patients underwent two trephines or two burr holes placed according to the maximum thickness of the hematoma. Rate of recurrence in trephine group was 12.5% and in burr-hole group was 11.76% and was not statistically significant. Significant factors for recurrence included nontraumatic cSDH, anticoagulant use, presence of membranes, preoperative computed tomography (CT) showing iso- or mixed-density subdural collection and SDH volume > 60 mL. There was selection bias for the procedure. Patients with subdural membranes were preferentially taken for TC as the percentage of subdural membrane found intraoperatively was significantly greater in trephine group (51.1%) than burr-hole group (17.6%) (p value < 0.001).When all the patients who showed membranes in CT scan were excluded, there was no statistical difference in the base line characteristics of both the groups. After excluding the patients with membranes in preoperative CT scan, there was no significant difference in recurrence rate between the two groups.In TC group with membranes, 8 out of 45 had recurrence, whereas in burr-hole group with membranes, 8 out of 12 had recurrence. This difference was statistically significant. (p value < 0.001). Conclusion Surgical intervention in both modalities improves patient outcome with an overall recurrence rate of 12.17%. In the absence of any identifiable membranes in preoperative CT scan, BHD is the preferred surgical intervention. We prefer TC as first choice for patients with membranes in CT scan.
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Edo, Suryopratomo1. "INVESTIGATION OF HOLE QUALITY AND TOOL WEAR IN HIGH-SPEED DRILLING OF AL 7050." Mechanical Engineering: An International Journal (MEIJ) 04, no. 1/2/3/4 (2023): 10. https://doi.org/10.5281/zenodo.7920272.
Full textAbstract:
This paper investigated the feasibility of drilling aluminum 7050 with enhanced cutting speed. Two identical tools and two identical Al-7050 work-piece plates were utilised during the experiment. Wet cooling drilling on both conventional and high cutting speeds was conducted to compare the results. A total of 338 holes were drilled towards the end of the experiment. Tests for tool wear, borehole diameter, and hole quality were carried out to observe the different drilling performances by drilling with different cutting speeds. The result shows that the proposed high speed drilling produced better diameter accuracy, better surface roughness but poor exit burr hole tendency
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Lind, Christopher R. P., Christina J. Lind, and Edward W. Mee. "Reduction in the number of repeated operations for the treatment of subacute and chronic subdural hematomas by placement of subdural drains." Journal of Neurosurgery 99, no. 1 (2003): 44–46. http://dx.doi.org/10.3171/jns.2003.99.1.0044.
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Object. The aim of this study was to determine the influence of closed-system subdural drainage on repeated operation rates after burr hole evacuation of subacute and chronic subdural hematomas (SDHs). Methods. Five hundred consecutive operations for the treatment of SDH via burr holes were performed between January 1, 1996, and April 15, 2002, at the Auckland Hospital. Hospital records were used to ascertain demographic data, operation, and repeated operation details. Rates of repeated surgeries were compared in patients with and without subdural drains. Repeated operations were performed less frequently in patients with subdural drains, occurring in 31 (10%) of 310 cases involving drains and in 35 (19%) of 188 cases without drains (p < 0.01). Demographics between the two groups were not significantly different except for mean patient age, which was higher among patients with a subdural drain. A lower rate of repeated operation was observed in patients who had undergone drain placement, regardless of whether there was visible evidence of brain reexpansion. Conclusions. Patients have lower rates of repeated surgeries if subdural drains are placed following evacuation of an SDH via a burr hole. To reach high clinical significance, 12 patients must undergo this simple intervention. If technically feasible, subdural drains should be inserted regardless of any occurrence of brain expansion during surgery.
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Ali, Md Amir, Md Aminul Islam, RU Chowdhury, et al. "Chronic Subdural Hematoma - A Dilemma to Put Drain." Bangladesh Journal of Neurosurgery 9, no. 1 (2019): 26–32. http://dx.doi.org/10.3329/bjns.v9i1.42921.
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Background: A chronic subdural hematoma (CSDH) is a collection of blood and blood breakdown products between the surface of the brain and its outermost covering the dura for more than 21 days. The elderly patients are more likely to develop a subdural hematoma, particularly from trivial trauma. CSDHs have been evacuated by burr holes, twist-drill craniotomies and craniotomies. The treatment of chronic subdural haematoma by burr hole drainage has been performed usually without using a closed drainage system, the problem of intracranial air entrapment still persists and can cause a deterioration in the level of consciousness or seizures in the postoperative period. We wanted to compare the effects of patient with drain and those without drain.
 Objectives: our study is to compare the clinical outcome of CSDH with or without drain.
 Methods: This prospective study was carried out at CMH Dhaka from January 2017 to July 2018; total 70 cases were investigated for the effectiveness of subdural drain. Cases were randomly allocated in two groups. Data were collected by specially designed questionnaire and analyzed by SPSS.
 Results and Observation: 70 patients of CSDH were included in this study out of which 25 underwent burr hole with closed system drainage and 45 underwent burr hole without closed system drainage. They were divided into Group A and B, respectively. Among the total number of patients 14 (20%) had shown recurrence. Out of 14 patients, 12 belong to Group B (86 %) and 2 belong to Group a (14 %).
 Conclusion: It is concluded that, those with a closed system drainage recurrence rate is significantly lower than with burr-hole evacuation alone.
 Bang. J Neurosurgery 2019; 9(1): 26-32
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Nathoo, Narendra, Syed Sameer Nadvi, Eleanor Gouws, and James R. van Dellen. "Craniotomy Improves Outcomes for Cranial Subdural Empyemas: Computed Tomography-Era Experience with 699 Patients." Neurosurgery 49, no. 4 (2001): 872–78. http://dx.doi.org/10.1097/00006123-200110000-00017.
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Abstract OBJECTIVE Uncertainty regarding the best surgical management for subdural empyemas (SDEs) continues. Our unit has considered craniotomy the preferred method of surgical drainage for all cranial SDEs since 1988. We performed an analysis of our previously published, computed tomography-era, experience with 699 patients. METHODS Two analyses of the database (1983–1997) were performed. First, analysis of the periods from 1983 to 1987 and from 1988 to 1997 was performed. Second, analysis of the composite database was performed. Outcomes were compared for possible outcome predictors by univariate analysis. Multivariate analysis was used to identify variables that contributed independently to outcomes, using stepwise discriminant analysis. RESULTS Significant correlations between the analyzed periods with respect to outcome and type of surgery (P = 0.001) were noted. Analysis of the entire database (1983–1997) revealed a significant relationship between outcome and surgery type (P = 0.05). Pairwise comparison of limited procedures such as burr holes or craniectomies with wide-exposure surgical procedures such as primary craniotomies or procedures proceeding to full craniotomies indicated significant correlation with outcomes (P = 0.027). Reoperation and morbidity rates were increased with limited procedures. Stepwise discriminant analyses revealed that the type of surgery was correlated with outcomes (P = 0.0008, partial r2 = 0.034). CONCLUSION Craniotomy was determined to be the surgical procedure of choice for treatment of cranial SDEs, allowing complete evacuation of the pus and, more importantly, decompressing the underlying cerebral hemisphere. Limited procedures such as burr holes or craniectomies may be performed for patients in septic shock, for patients with parafalcine empyemas, or for children with SDEs secondary to meningitis.
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Cenic, Aleksa, Mohit Bhandari, and Kesava Reddy. "Management of Chronic Subdural Hematoma: A National Survey and Literature Review." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 32, no. 4 (2005): 501–6. http://dx.doi.org/10.1017/s0317167100004510.
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ABSTRACT:Objective:To survey neurosurgical practices in the treatment of chronic and subacute subdural hematoma in the Canadian adult population.Methods:We developed and administered a questionnaire to Canadian Neurosurgeons with questions relating to the management of chronic and subacute subdural hematoma. Our sampling frame included all neurosurgery members of the Canadian Neurosurgical Society.Results:Of 158 questionnaires, 120 were returned (response rate = 76%). The respondents were neurosurgeons with primarily adult clinical practices (108/120). Surgeons preferred one and two burr-hole craniostomy to craniotomy or twist-drill craniostomy as the procedure of choice for initial treatment of subdural hematoma (35.5% vs 49.5% vs 4.7% vs 9.3%, respectively). Craniotomy and two burr-holes were preferred for recurrent subdural hematomas (43.3% and 35.1%, respectively). Surgeons preferred irrigation of the subdural cavity (79.6%), use of a subdural drain (80.6%), and no use of anti-convulsants or corticosteroids (82.1% and 86.6%, respectively). We identified a lack of consensus with keeping patients supine following surgery and post-operative antibiotic use.Conclusion:Our survey has identified variations in practice patterns among Canadian Neurosurgeons with respect to treatment of subacute or chronic subdural hematoma (SDH). Our findings support the need for further prospective studies and clinical trials to resolve areas of discrepancies in clinical management and hence, standardize treatment regimens.
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Cardoso, Erico R., Radwa Abbas, Emily M. Stone, and Shivali Patel. "Combined pterional burr hole and coagulation of middle meningeal artery for chronic subdural hematoma." Surgical Neurology International 15 (July 26, 2024): 254. http://dx.doi.org/10.25259/sni_180_2024.
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Background: There are many surgical techniques to treat chronic subdural hematomas (CSHs). However, they all have high recurrence rates. Recently, embolization of the middle meningeal artery (MMA) following surgical evacuation of CSH has reduced the recurrence rate. We investigated the feasibility of combining the surgical obliteration of the MMA at the same time as the placement of a burr hole for evacuation of the CSH. Case Description: We report on nine patients who underwent 11 of these combined procedure by the same surgeon in two hospitals, including clinical data and images during the perioperative and postoperative periods. Cardoso had previously reported details of the surgical technique. Two patients underwent bilateral procedures. Two patients had two burr holes because the hematomas did not extend caudally to the pterion, where the MMA enters the calvarium. Intraoperative fluoroscopy was used to locate the point of entry of the MMA into the calvarium in most cases, except in two instances when navigation was utilized. Conclusion: This small series of nine cases suggests the feasibility of using this combined procedure as an additional option to the treatment of CSHs, especially where endovascular treatment might not be readily available. Furthermore, it has the potential advantages of safety, efficacy, avoidance of a second endovascular procedure, faster disappearance of the subdural collection, lesser exposure to radiation, and cost containment. Larger prospective controlled series are needed to identify its potential usefulness.
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Berger, Mitchel S. "Ultrasound-guided stereotaxic biopsy using a new apparatus." Journal of Neurosurgery 65, no. 4 (1986): 550–54. http://dx.doi.org/10.3171/jns.1986.65.4.0550.
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✓ A skull-mounted apparatus is described for use with ultrasound probes 16 mm in diameter (5.0-MHz probes for near-field and 7.5-MHz probes for far-field lesions). The system permits ultrasound-guided stereotaxic biopsy of intracranial lesions through a burr hole in awake or anesthetized patients. This apparatus has been used in 19 patients for biopsy of central nervous system lesions 1.5 to 5 cm in diameter and for drainage of abscess cavities and cysts. The time required to obtain a tissue sample after incision of the skin ranged from 25 to 40 minutes. The only complication was a delayed hemorrhage in a patient with acquired immunodeficiency syndrome. The advantages of this method over those guided by computerized tomography (CT) include less time required for the entire procedure, immediate confirmation of the biopsied target by imaging the echogenic needle track, assessment of cyst or abscess drainage, and detection of hemorrhage within minutes after biopsy. The apparatus may be especially useful in pediatric patients because it obviates the need for general anesthesia during transport to and from the CT scanner. This ultrasound-guided system does not require a craniotomy, craniectomy, or two separate burr holes.
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Yamada, Shoko Merrit, Katsuya Gorai, and Koichi Gonda. "Pinwheel-Shaped Titanium Plates Should Be Fixed to the Skull Using All Screw Holes to Protect the Plates from Being Bent." Case Reports in Surgery 2019 (August 19, 2019): 1–3. http://dx.doi.org/10.1155/2019/5709285.
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Introduction. In cranioplasty, pinwheel-shaped titanium mini plates are frequently used to cover bone defects produced by burr holes, and it is common to insert screws through only a few of the holes in cranial flap fixation. Presentation of Case. A 69-year-old man who had undergone clipping surgery for subarachnoid hemorrhage 16 years previously visited our clinic because a titanium plate had penetrated his scalp one month after he was hit on the head by a wall cabinet. Imaging studies revealed that part of the titanium plate had bent outwards and penetrated the skin. The plate was surgically removed, a relief skin incision was made 6 cm posterior to the skin defect to suture the defected portion without causing tension, and a skin graft was applied to the relief skin incision portion. Two months after the maneuver, the skin graft had been successfully incorporated without infection. Discussion. Even after the subcutaneous and the cutaneous tissue have completely covered the pinwheel-shaped titanium mini plate, an edge without screw fixation can be easily bent by a hard blow to the overlying scalp. We recommend fixation of pinwheel-shaped titanium plates used in cranioplasty through all screw holes to protect against the plate being bent.
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Abdelfatah, MohamedAbdel Rahman. "Recurrence rate of chronic subdural hematoma after evacuating it by two large burr holes, irrigation, and subgaleal low-pressure suction drainage." Asian Journal of Neurosurgery 14, no. 3 (2019): 725. http://dx.doi.org/10.4103/ajns.ajns_321_17.
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Gill, Maneet, Vikas Maheshwari, Amit Narang, and T. S. Lingaraju. "Impact on Cognitive Improvement Following Burr Hole Evacuation of Chronic Subdural Hematoma: A Prospective Observational Study." Journal of Neurosciences in Rural Practice 09, no. 04 (2018): 457–60. http://dx.doi.org/10.4103/jnrp.jnrp_126_18.
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ABSTRACT Objective: Patients of Chronic subdural haematoma can present with only subtle cognitive impairment without any motor deficit. It is hence imperative for the treating clinician to be aware of this entity. The aim of the study was to identify any statistically significant improvement of cognitive functions following burr hole evacuation of Chronic SDH especially in the elderly patients. Methods and Material: A Prospective observational study of 30 patients of CSDH, from Jan 2015 to Dec 2016 was done at a tertiary level Armed Forces Hospital. The study had 23 male, 07 female, with age ranging from 7-85 years. The cognitive function of each patient was assessed at admission and 24 hours after surgery by MMSE. Radiological confirmation was done by CT head. Standard two burr holes were made and hematoma evacuated. The clinical, cognitive assessment and radiological data were collected and analysed. Results: There was no statistical significance preoperatively between age and pre operative cognitive impairment, headache, hemiparesis, dysarthria (P>0.05). We however found a statistically significant improvement postoperatively in cognitive impairment, headache (P=0.00), motor deficit (P=0.01) and dysarthria (P=0.046) Conclusion: The clinical features of dementia and other neurodegenerative disorders simulate CSDH in the geriatric population. These patients should have early neuroimaging and prompt surgical intervention to alleviate cognitive deficits.
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Khilji, Muhammad Faisal, Niranjan Lal Jeswani, Rana Shoaib Hamid, and Faisal Al Azri. "Spontaneous Arachnoid Cyst Rupture with Subdural Hygroma in a Child." Case Reports in Emergency Medicine 2016 (2016): 1–3. http://dx.doi.org/10.1155/2016/6964713.
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Arachnoid cyst of the brain is common in children but its association with spontaneous subdural hygroma is rare. A case of a nine-year-old boy, without any preceding history of trauma, is presented here who came to the emergency department of a tertiary care hospital with complaints of headache, nausea, and vomiting for the last two weeks but more for the last two days. Examination showed a young, fully conscious oriented boy with positive Cushing’s reflex and papilledema of left eye. MRI (magnetic resonance imaging) of the brain showed left temporal extra-axial cystic lesion of 5.40 × 4.10 cm in size, representing arachnoid cyst, with bilateral frontoparietal subdural hygromas. Cyst was partially drained through left temporal craniectomy and subdural hygromas were drained through bilateral frontal burr holes. Postoperatively the child recovered uneventfully and was discharged on the seventh postoperative day. Histopathology proves it to be arachnoid cyst of the brain with subdural CSF (cerebrospinal fluid) collection or hygroma.
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Syal, R., H. Singh, and K. K. Duggal. "Otogenic brain abscess: management by otologist." Journal of Laryngology & Otology 120, no. 10 (2006): 837–41. http://dx.doi.org/10.1017/s0022215106001903.
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Introduction: Fifty per cent of brain abscesses in adults and 25 per cent of those in children are otogenic in origin. The current neurosurgical options are to drain the abscess repeatedly through burr holes or to excise it completely with the capsule. We successfully managed 10 cases of brain abscess by draining through the transmastoid route. The technique and its advantages are discussed.Material and methods: The patients underwent surgery at two different institutions. Computed tomography scanning and magnetic resonance imaging were performed, along with diffusion-weighted imaging and in vivo proton magnetic resonance spectroscopy. The abscesses were drained via a transmastoid route.Results: In eight cases, ear disease and brain abscess were treated in a single-stage procedure. In the remaining two cases, residual brain abscess was excised subsequently by our neurosurgical colleagues.Conclusions: Transmastoid drainage of pus can successfully treat mastoid disease and brain abscess in a single surgical intervention. Residual abscess can be subsequently excised, with relatively reduced morbidity. Repeated needling is also avoided with this approach. Diffusion-weighted imaging and proton magnetic resonance spectroscopy are helpful.
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Thiam, AB,. "Coexistence d’un hématome sous dural chronique et un empyème sous-dural controlatéral : à propos d’un ca." Journal Africain de Chirurgie 1, no. 3 (2012): 176–80. http://dx.doi.org/10.61585/pud-jafrchir-v1n308.
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Chronic sub-dural hematoma and subdural empyema are well known neurosurgical pathologies. Their coexistence is rare. The authors refered a case and discussed the various causes with a review of the literature. Comments : This is a 73 year-old woman, with a history of Alzheimer’s disease and cerebrovascular accident (CVA) treated with Salicylate acid 100 mg / day, who presented disturbance of consciousness and right hemiparesis. No notion of fever or head injury was founded. A Computed tomography (CT) scan without injection of contrast evoked the diagnosis of bilateral chronic subdural hematoma. The patient underwent surgery in emergency for neurological deterioration. After completion of two parietal burr holes from both sides and opening the dura, it was founded a chronic subdural hematoma (CSDH) on the left and a thick hard inflammatory membrane on the right, which contained a purulent material. Culture revealed Escherichia coli. Conclusion: Subdural empyema resulting from hematogenous seeding into a preexisting subdural hematoma is very rare.
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Jaweed, Mohammad, Dollicia Toh Ching Ying, Esther Sim Wan Rong, Mohammad Yasin, and Azmin Kass Rosman. "Cryptogenic subdural empyema mimicking subacute-subdural hematoma on CT imaging in the pediatric group: a clinical case series." Archives of Pediatric Neurosurgery 5, no. 1 (2023): e1662023. http://dx.doi.org/10.46900/apn.v5i1.166.
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Introduction: Subdural empyema (SDE) is a rare but potentially life-threatening intracranial infection that is invariably fatal if left untreated. As clinical and radiologic features may be subtle or uncertain, early diagnosis may be a challenge but is crucial in reducing morbidity and mortality. SDE should always be suspected especially in a paediatric group with a history of fever, focal seizures, meningism and neurological deficit. The management of SDE has been debated in the literature for decades. Being one of the most serious neurosurgical emergencies, goals include surgical evacuation where both burr-hole drainage and craniotomy are primary surgical options, treatment of pus, and establishing the etiologic agent which subsequently guides antibiotic therapy for a favourable outcome.
 Case presentation: We present three cases of immunocompetent patients, 4 and 6-month-old infants with a 14-year-old adolescent presenting with SDE without underlying risk factors. Non-contrast computed tomography imaging was equivocal for SDE. All of them required surgery. The two infants underwent burr holes and subsequently a wide craniotomy with intravenous antibiotics therapy while the adolescent required craniectomy because of swollen brain. They all had a favourable outcome on long term follow up.
 
 Conclusion: Paediatric supratentorial SDE, although rapidly fatal if not identified promptly, can be effectively managed with early surgical drainage preferably craniotomy, eradication of the source, and sensitive IV broad-spectrum antibiotics. In this article, we discuss the clinical presentation, diagnostic tools, treatment options and outcomes for SDE with an emphasis on the challenges.
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von Kummer, Rüdiger, and Sigrid Herold. "Hydrogen Clearance Method for Determining Local Cerebral Blood Flow. I. Spatial Resolution." Journal of Cerebral Blood Flow & Metabolism 6, no. 4 (1986): 486–91. http://dx.doi.org/10.1038/jcbfm.1986.83.
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To define the effective spatial resolution of the hydrogen clearance method, serial local CBF (LCBF) measurements were performed at different distances from the cortico–white matter junction of the cat brain. Twenty-five platinum-wire microelectrodes with a sensitive surface of 0.07 mm2 were inserted into the cerebral cortex of three cats through burr holes in the skull and advanced toward the ear-to-ear level in 1- or 0.1-mm steps. Most electrodes passed from high-perfusion regions into low-perfusion areas, indicating that the cortico–white matter junction had been traversed. Whereas within the gray and white matter the LCBF values were fairly constant, a striking decrease of CBF was registered at the cortico–white matter junction. Here the mean LCBF from 12 electrodes showed significant differences in flow between two locations 1 mm apart. On two occasions, a significant difference in CBF was found for locations only 0.1 mm apart. Despite this high spatial resolution, monoexponential clearance curves were detected only in the vicinity of the cortico–white matter junction. It is therefore assumed that factors other than flow might influence H2 clearance.
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Clark, Peter A. "Placebo Surgery for Parkinson's Disease: Do the Benefits Outweigh the Risks?" Journal of Law, Medicine & Ethics 30, no. 1 (2002): 58–68. http://dx.doi.org/10.1111/j.1748-720x.2002.tb00720.x.
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In April 1999, Dr. Curt Freed of the University of Colorado in Denver and Dr. Stanley Fahn of Columbia Presbyterian Center in New York presented the results of a four-year, $5.7 million government-financed study using tissue from aborted fetuses to treat Parkinson’s disease at a conference of the American Academy of Neurology. The results of the first government-financed, placebo-controlled clinical study using fetal tissue showed that the symptoms of some Parkinson’s patients had been relieved. This research study involved forty subjects, nineteen women and twenty-one men; all suffered from Parkinson’s disease for an average of 13.5 years. In the study, each subject underwent neurosurgery: “four tiny burr holes, drilled through the wrinkle lines above the eyebrows into the skull, to clear a pathway to the brain. But only half received injections of fetal cells into the putamen, the region of the brain that controls movement; the other half received nothing. One year later, three members of the placebo group said their symptoms had improved.” In two-thirds of the transplant recipients, the fetal tissue took hold and seemed to establish a new network to produce the missing neurochemical dopamine.
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Schroeder, Henry W. S., Michael R. Gaab, and Wulf-Rüdiger Niendorf. "Neuroendoscopic approach to arachnoid cysts." Journal of Neurosurgery 85, no. 2 (1996): 293–99. http://dx.doi.org/10.3171/jns.1996.85.2.0293.
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✓ A prospective study of seven consecutive patients with congenital arachnoid cysts treated endoscopically is reported. The ages of the patients at the time of diagnosis ranged from 6 to 47 years with three patients under 15 years. Two cysts were located in the posterior cranial fossa, four in the middle cranial fossa, and one in the suprasellar—prepontine area. The patients' symptoms included headache, seizures, vomiting, nausea, dizziness, balance problems, and precocious puberty. The authors performed cystocisternostomies and ventriculocystostomies via burr holes with the aid of a universal neuroendoscopic system. Minor bleeding was easily controlled by rinsing. In one case, the endoscopic procedure had to be abandoned because of significant bleeding, which obscured a clear operative view, and an open microsurgical cyst fenestration was performed. The follow-up review periods in this group of patients ranged from 15 to 30 months. There was no mortality or morbidity. Symptoms were relieved in five patients and improved in one. Precocious puberty in one case continued. In six cases, follow-up magnetic resonance images or computerized tomography scans revealed a decrease in the size of the cysts. Although the follow-up period is too short to make statements on long-term outcome, the authors recommend the minimally invasive endoscopic approach for treatment of arachnoid cysts as the first therapy of choice. Should the endoscopic procedure fail, established treatment options such as microsurgical fenestration or cystoperitoneal shunting can subsequently be performed without causing additional risk to the patient.
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Montoya, Maxime, Madalina Calamaz, Daniel Gehin, and Franck Girot. "Numerical Simulation of Workpiece Thermal Field in Drilling CFRP/Aluminum Alloy." Key Engineering Materials 611-612 (May 2014): 1226–35. http://dx.doi.org/10.4028/www.scientific.net/kem.611-612.1226.
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Machining is a process implying extremely high coupled thermo-mechanical stresses. The workpiece mechanical properties decrease with the temperature generated during the process and that temperature has a direct influence on wear intensity undergone by the tool. In the case of a drilling operation, the temperature generated by the cutting process can lead to metal burr formation and/or composite matrix degradation by burning. When these two materials are used in the form of a sandwich-type stacking, the temperature attained in the metallic part can cause new defects such as: i) a difference between the diameters measured in each material and ii) organic matrix damages due to heat diffusion from the metal towards the CFRP layer. Temperature reached at the tool/workpiece interface is difficult to measure during drilling operation, due to its enclosed configuration; numerical simulation is therefore a good alternative to access to this information. The purpose of this study is to develop and carry out numerical simulations in order to estimate the workpiece thermal field generated during drilling. The simulations are validated by comparing simulated and measured temperatures at 4 mm from the holes wall. This method is applied to evaluate thermal field generated during drilling (with chip removing cycles) of CFRP/Aluminum alloy stacks. The influence of the drilling kinematics on the workpiece thermal field is also investigated.
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Scalia, Gianluca, Salvatore Marrone, Roberta Costanzo, et al. "Bilateral post-traumatic hygromas in patient with frontotemporal dementia." Surgical Neurology International 13 (December 30, 2022): 597. http://dx.doi.org/10.25259/sni_1056_2022.
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Background: Frontotemporal dementia (FTD) is a highly disabling neurologic disorder characterized by behavioral alterations and movement disorders, involving patients with a mean age of 58 years. We present a unique case of a patient suffering from FTD who developed post traumatic bilateral hygromas. Case Description: A 52-year-old male patient, with an history of head trauma 3 months before, was admitted to our department for recurrent motor seizures. Anamnesis was positive for FTD with severe frontal syndrome. Brain computed tomography and magnetic resonance imaging (MRI) showed the typical “knife-blade” appearance of the cortical atrophy associated to bilateral hemispheric hygromas exerting mild mass effect. Brain MRI showed the signs of the cortical and “anti-cortical” vein. The two subdural collections were evacuated through two bilateral burr holes and controlled drainage. Despite anti-epileptic drugs therapy, in the early postoperative period, the patient presented further tonic-clonic seizures. The patient showed progressive recovery and was transferred to the neurorehabilitation center. After 6-month follow-up, he completely recovered. Conclusion: In FTD, severe cortical atrophy leads to space increase between arachnoid and pia mater that could affect the anatomical integrity especially after trauma, with possible development of hygromas. The coexistence of radiological findings of the cortical vein and sign of the “anti-cortical” vein can make difficult an exact differential diagnosis between a primitive hygroma and a Virchow hygroma from resorption of previous blood collection. Surgical treatment may be indicated in selected patients, but it is burdened by higher postoperative risks compared to the general population.
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Kitya, David, Maria Punchak, Jihad Abdelgadir, Oscar Obiga, Derek Harborne, and Michael M. Haglund. "Causes, clinical presentation, management, and outcomes of chronic subdural hematoma at Mbarara Regional Referral Hospital." Neurosurgical Focus 45, no. 4 (2018): E7. http://dx.doi.org/10.3171/2018.7.focus18253.
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OBJECTIVECauses, clinical presentation, management, and outcomes of chronic subdural hematoma (CSDH) in low- and middle-income countries are not well characterized in the literature. Knowledge regarding these factors would be beneficial in the development and implementation of effective preventive and management measures for affected patients. The authors conducted a study to gain a better understanding of these factors in a low-income setting.METHODSThis prospective study was performed at Mbarara Regional Referral Hospital (MRRH) in Uganda between January 2014 and June 2017. Patients of any age who presented and were diagnosed with CSDH during the aforementioned time period were included in the study. Variables were collected from patients’ files at discharge and follow-up clinic visits. The primary outcome of interest was death. Secondary outcomes of interest included discharge Glasgow Coma Scale (GCS) score, ICU admission, wound infection, and CSDH recurrence.RESULTSTwo hundred five patients, the majority of whom were male (147 [72.8%]), were enrolled in the study. The mean patient age was 60.2 years (SD 17.7). Most CSDHs occurred as a result of motor vehicle collisions (MVCs) and falls, 35.6% (73/205) and 24.9% (51/205), respectively. The sex ratio and mean age varied depending on the mechanism of injury. Headache was the most common presenting symptom (89.6%, 173/193), whereas seizures were uncommon (11.5%, 23/200). Presenting symptoms differed by age. A total of 202 patients underwent surgical intervention with burr holes and drainage, and 22.8% (46) were admitted to the ICU. Two patients suffered a recurrence, 5 developed a postoperative wound infection, and 18 died. Admission GCS score was a significant predictor of the discharge GCS score (p = 0.004), ICU admission (p < 0.001), and death (p < 0.001).CONCLUSIONSTrauma from an MVC is the commonest cause of CSDH among the young. For the elderly, falling is common, but the majority have CSDH with no known cause. Although the clinical presentation is broad, there are several pronounced differences based on age. Burr hole surgery plus drainage is a safe and reliable intervention. A low preoperative GCS score is a risk factor for ICU admission and death.
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López de Lacalle, Luis Norberto, Gorka Urbikain Pelayo, Ibon Azkona, et al. "Functional Layers of Aluminium Alloy on Steel Made by Alternative Friction Processes, for Elements of Metal Structures." Advanced Materials Research 1146 (April 2018): 106–14. http://dx.doi.org/10.4028/www.scientific.net/amr.1146.106.
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Coating of steel with aluminium alloy is needed for the execution of a functional layer for corrosion protection. Some experiments have been performed on square-section tubes (50 mm x 50 mm) of S235 steel, according to EN 10 025, to be coated with 1 mm thick sheets of EN AW 5754 aluminium alloy that have been previously bended as U shaped profiles. A new experimental model of specialized equipment has been used for certain experiments to make these functional layers of aluminium alloy on steel. Firstly, friction drilling and threading by form tapping, followed by screws-mounting without nuts have been used to make such joints. Several holes have been executed by a Ø4.3 friction drilling tool, then an M5 form tap was used for threading. For friction drilling, tools with 90% tungsten carbide content and 1 micron grain size were applied. By threading, TiN coated form taps have been used. Secondly, overlap friction stir welding (FSW) has been applied, to make a functional layer of aluminium alloy on a 50 mm x 50 mm S235 steel tube. The wings of the U profiles were overlapped. A quenched FSW tool, own-made of C 45 grade steel, EN 10083, has been used for these joining tests. The joining parameters are mentioned for each process. The run of each joining process is described and the joint test samples are presented. The appearance of the screw-mounted functional layers is appropriate. The metallographic analysis has revealed adequate form of the burr formed below the hole. The burr height is 2.5 – 3.2 mm. The pattern of the M5 thread is appropriate. No defects have been detected on the holes and threads. The appearance of the FSW functional layers is adequate. Metallographic analysis shows that FSW joints of the overlapped aluminium alloy sheets are adequate, because there is no gap between these sheets. There is only a narrow gap between the aluminium alloy bottom sheet and the wall of the steel tube, which proves an appropriate positioning of the two metals. No defects were detected, except for a weld flaw, as a small and isolated cavity, with a section less than 0.1 mm2, considered within the acceptance limit, according to EN 25239-5. The U shaped sheets of aluminium alloy are firmly fixed on the square steel tube, for both coating types. The mentioned processes are proposed to increase productivity in industrial technologies for series production. The processes addressed in this paper are more rapid than conventional processes. Adequate preparation of the parts to be welded, mechanization and automation allow repeatability and quality. The target applications are coated structure elements for devices, appliances, tools, welded structures or automobiles. The involved industrial areas of the applications are: manufacturing, electro-technique, construction and automotive industries. The presented processes are ecological, because they do not need lubricants or other toxic substances and do not produce chips or harmfull substances.
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Parandoush, Pedram, Palamandadige Fernando, Hao Zhang, et al. "A finishing process via ultrasonic drilling for additively manufactured carbon fiber composites." Rapid Prototyping Journal 27, no. 4 (2021): 754–68. http://dx.doi.org/10.1108/rpj-10-2019-0260.
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Purpose Additively manufactured objects have layered structures, which means post processing is often required to achieve a desired surface finish. Furthermore, the additive nature of the process makes it less accurate than subtractive processes. Hence, additive manufacturing techniques could tremendously benefit from finishing processes to improve their geometric tolerance and surface finish. Design/methodology/approach Rotary ultrasonic machining (RUM) was chosen as a finishing operation for drilling additively manufactured carbon fiber reinforced polymer (CFRP) composites. Two distinct additive manufacturing methods of fused deposition modeling (FDM) and laser-assisted laminated object manufacturing (LA-LOM) were used to fabricate CFRP plates with continuous carbon fiber reinforcement. The influence of the feedrate, tool rotation speed and ultrasonic power of the RUM process parameters on the aforementioned quality characteristics revealed the feasibility of RUM process as a finishing operation for additive manufactured CFRP. Findings The quality of drilled holes in the CFRP plates fabricated via LA-LOM was supremely superior to the FDM counterparts with less pullout delamination, smoother surface and less burr formation. The strong interfacial bonding in LA-LOM proven to be superior to FDM was able to endure higher cutting force of the RUM process. The cutting force and cutting temperature overwhelmed the FDM parts and induced higher surface damage. Originality/value Overall, the present study demonstrates the feasibility of a hybrid additive and subtractive manufacturing method that could potentially reduce cost and waste of the CFRP production for industrial applications.
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Dr., Humera Karim Ayesha Yousaf Hamna Iqbal. "A RESEARCH STUDY TO ASSESS THE ASSOCIATION OF ASSOCIATED RISK FACTORS OF BURR HOLE SURGERY FOR REOCCURRENCE OF CHRONIC SUBDURAL HEMATOMA." INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES o6, no. 03 (2019): 5453–57. https://doi.org/10.5281/zenodo.2594092.
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<strong><em>Background:</em></strong><em> The incidence of chronic subdural hematoma (CSDH) is mostly found in elderly patients. In daily neurosurgical operation, the most frequently found entity is a chronic subdural hematoma. It is a common type of intracranial haemorrhage.</em> <strong><em>Objective:</em></strong><em> The objective of this study was to assess the prevalence of and associated factors of chronic subdural hematoma repeating after burr hole surgery.</em> <strong><em>Patients and Methods:</em></strong><em> The current study was arranged at Jinnah Hospital, Lahore (October 2017 to September 2018). The patients selected for this study were identified as CSDH. On carrying out computed tomography (CT), the identification was confirmed. Through hematoma evacuation and drainage by cranial bur hole, the disease was managed. Regular computed tomography (CT) one day after surgery, one week after surgery and two months after surgery was carried out in all the patients. In order to measure the repeating rate, results of before and after CT scan were compared. The value of P was (0.05) which was taken as significant. SPSS was used for data entry and assessment.</em> <strong><em>Results:</em></strong><em> The percentage of male and female was 72.64% and 27.36% respectively. The age of 78.31% of patients was under 70 years. 10.8% (12) patients were found with repetition of a chronic subdural hematoma after the bull holes craniotomy. Re-expansion of the brain after operation and age equal to 70 years were the factors responsible for this repetition. According to the results of CT Scan, CSDH as hypodense to cerebral parenchyma is dense and hyperdense were observed in 49.05%, 29.24% and 21.7% patients respectively.</em> <strong><em>Conclusion:</em></strong><em> The results showed that re-expansion of the brain after operation and age were the factors responsible for the repetition of chronic subdural hematoma.</em> <strong>Keywords:</strong> <em>Chronic Subdural Hematoma (CSDH), Expansion, Brain, Surgery and Operation.</em>
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Sondhi, Dolan, Stephen M. Kaminsky, Neil R. Hackett, et al. "Slowing late infantile Batten disease by direct brain parenchymal administration of a rh.10 adeno-associated virus expressing CLN2." Science Translational Medicine 12, no. 572 (2020): eabb5413. http://dx.doi.org/10.1126/scitranslmed.abb5413.
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Late infantile Batten disease (CLN2 disease) is an autosomal recessive, neurodegenerative lysosomal storage disease caused by mutations in the CLN2 gene encoding tripeptidyl peptidase 1 (TPP1). We tested intraparenchymal delivery of AAVrh.10hCLN2, a nonhuman serotype rh.10 adeno-associated virus vector encoding human CLN2, in a nonrandomized trial consisting of two arms assessed over 18 months: AAVrh.10hCLN2-treated cohort of 8 children with mild to moderate disease and an untreated, Weill Cornell natural history cohort consisting of 12 children. The treated cohort was also compared to an untreated European natural history cohort of CLN2 disease. The vector was administered through six burr holes directly to 12 sites in the brain without immunosuppression. In an additional safety assessment under a separate protocol, five children with severe CLN2 disease were treated with AAVrh.10hCLN2. The therapy was associated with a variety of expected adverse events, none causing long-term disability. Induction of systemic anti-AAVrh.10 immunity was mild. After therapy, the treated cohort had a 1.3- to 2.6-fold increase in cerebral spinal fluid TPP1. There was a slower loss of gray matter volume in four of seven children by MRI and a 42.4 and 47.5% reduction in the rate of decline of motor and language function, compared to Weill Cornell natural history cohort (P < 0.04) and European natural history cohort (P < 0.0001), respectively. Intraparenchymal brain administration of AAVrh.10hCLN2 slowed the progression of disease in children with CLN2 disease. However, improvements in vector design and delivery strategies will be necessary to halt disease progression using gene therapy.
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Limpastan, Kriengsak, Thunya Norasetthada, Wanarak Watcharasaksilp, et al. "Intracranial pressure monitoring for severe traumatic brain injury retrospective study of 273 consecutive patients." Surgical Neurology International 15 (June 21, 2024): 208. http://dx.doi.org/10.25259/sni_221_2024.
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Background: Intracranial pressure (ICP) monitoring is essential in severe traumatic brain injury (sTBI) cases; yet, the frequency of high ICP occurrences remains debated. This study presents a 9-year analysis of ICP monitoring using intraventricular catheters among sTBI patients. Methods: A retrospective review of 1760 sTBI patients (Glasgow Coma Score <9) admitted between January 2011 and December 2019 was conducted. Of these, 280 patients meeting monitoring criteria were included based on Brain Trauma Foundation (BTF) Guidelines. ICP was monitored using intraventricular catheters through right frontal burr holes. Initial ICP readings were recorded intraoperatively, followed by continuous monitoring. Patients with ICP >20 mmHg for 10–15 min during 72 h were categorized with high ICP. Data collected included demographics, computed tomography (CT) findings, intra- and post-operative ICP, and complications. Results: Of 273 patients, 228 were male and 45 females, aged 18–80 (71.30% aged 18–45). Traffic accidents were the primary cause (90.48%). Fifty-two-point 75% experienced high ICP, correlating significantly with subdural hematoma (P < 0.001), intraventricular hemorrhage (P < 0.013), and compressed basal cisterns (P = 0.046) on initial CT. Twenty patients (7.3%) developed meningitis. Lower mortality rates and improved outcomes were observed in the low ICP group across discharge 3-and 6-month follow-ups. Conclusion: Adherence to BTF guidelines yielded a 52.75% high ICP rate. Significant correlations were found between high ICP and specific CT abnormalities. This study underscores the benefits of ICP monitoring in selected sTBI cases, suggesting a need to review criteria for initiating monitoring protocols.