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Neurosurgical Interventions in Neurological Emergencies

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Emergencies in Neurology

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Abstract

Patients harbouring neurological diseases may require urgent neurosurgical interventions. Acute ischaemic stroke (AIS) is managed by neurologists. For the select group of patients who develop malignantly raised intracranial pressure (ICP), urgent surgical intervention is required. Most of the neurological conditions requiring surgical interventions are secondary to a raised ICP, which may in turn be due to parenchymal swelling, mass effect or obstructed cerebrospinal fluid (CSF) pathways.

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References

  1. Merenda A, DeGeorgia M. Craniectomy for acute ischemic stroke: how to apply the data to the bedside. Curr Opin Neurol. 2010;23:53–8.

    Article  Google Scholar 

  2. Unterberg A, Juettler E. The role of surgery in ischemic stroke: decompressive surgery. Curr Opin Crit Care. 2007;13:175–9.

    PubMed  Google Scholar 

  3. Doerfler A, Forsting M, Reith W, et al. Decompressive craniectomy in a rat model of ‘malignant’ cerebral hemispherical stroke: experimental support for an aggressive therapeutic approach. J Neurosurg. 1996;85:853–9.

    Article  CAS  Google Scholar 

  4. Forsting M, Reith W, Schäbitz WR, et al. Decompressive craniectomy for cerebral infarction: an experimental study in rats. Stroke. 1995;26:259–64.

    Article  CAS  Google Scholar 

  5. Hennerici M, Jüttler E, Schmiedek P, Schwab S, Unterberg A, Woitzik J, et al. Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY): a randomized, controlled trial. Stroke. 2007;38:2518–25.

    Article  Google Scholar 

  6. Guichard JP, Kurtz A, Mateo J, Orabi M, Vahedi K, Vicaut E, et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL trial). Stroke. 2007;38:2506–17.

    Article  Google Scholar 

  7. Algra A, Amelink GJ, Hofmeijer J, Kappelle LJ, van der Worp HB, van Gijn J, HAMLET Investigators. Surgical decompression for space-occupying cerebral infarction (the hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 2009;8:326–33.

    Article  Google Scholar 

  8. Alexander P, Heels-Ansdell D, Siemieniuk R, et al. Hemicraniectomy versus medical treatment with large MCA infarct: a review and meta-analysis. BMJ Open. 2016;6:e014390.

    Article  Google Scholar 

  9. Schwab S, Steiner T, Aschoff A, et al. Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke. 1998;29:1888–93.

    Article  CAS  Google Scholar 

  10. Rabinstein AA, Mueller-Kronast N, Maramattom BV, et al. Factors predicting prognosis after decompressive hemicraniectomy for hemispheric infarction. Neurology. 2006;67:891–3.

    Article  CAS  Google Scholar 

  11. Amiri H, Bösel J, Jüttler E, Sakowitz OW, Unterberg A, Woitzik J, et al. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med. 2014;370:1091–100.

    Article  Google Scholar 

  12. Güresir E, Vatter H, Schuss P, et al. Rapid closure technique in decompressive craniectomy. J Neurosurg. 2011;114(4):954–60.

    Article  Google Scholar 

  13. Mukherjee KK, Mohindra S, Gupta SK, et al. True hemicranial decompression for severe pediatric cranial trauma: a short series of 4 cases and literature review. Surg Neurol. 2006;66:305–10.

    Article  Google Scholar 

  14. Ucar T, Akyuz M, Kazan S, et al. Role of decompressive surgery in the management of severe head injuries: prognostic factors and patient selection. J Neurotrauma. 2005;22:1311–8.

    Article  Google Scholar 

  15. Compagnone C, Murray GD, Teasdale GM, et al. The management of patients with intra-dural post-traumatic mass lesions: a multicenter survey of current approaches to surgical management in 729 patients coordinated by the European Brain Injury Consortium. Neurosurgery. 2005;57:1183–92.

    Article  Google Scholar 

  16. Stefini R, Latronico N, Cornali C, et al. Emergent decompressive craniectomy in patients with fixed dilated pupils due to cerebral venous and dural sinus thrombosis: report of three cases. Neurosurgery. 1999;45:626–30.

    Article  CAS  Google Scholar 

  17. Allroggen H, Abbott RJ. Cerebral venous sinus thrombosis. Postgrad Med J. 2000;76:12–5.

    Article  CAS  Google Scholar 

  18. Keller E, Pangalu A, Fandino J, et al. Decompressive craniectomy in severe cerebral venous and dural sinus thrombosis. Acta Neurochir Suppl. 2005;94:177–83.

    Article  CAS  Google Scholar 

  19. Théaudin M, Crassard I, Bresson D, et al. Should decompressive surgery be performed in malignant cerebral venous thrombosis?: a series of 12 patients. Stroke. 2010;41:727–31.

    Article  Google Scholar 

  20. Weber J, Spring A. Unilateral decompressive craniectomy in left transverse and sigmoid sinus thrombosis. Zentralbl Neurochir. 2004;65:135–40.

    Article  CAS  Google Scholar 

  21. Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol. 2007;6:162–70.

    Article  CAS  Google Scholar 

  22. Newman CB, Pakbaz RS, Nguyen AD, et al. Endovascular treatment of extensive cerebral sinus thrombosis. J Neurosurg. 2009;110:442–5.

    Article  Google Scholar 

  23. Aaron S, Alexander M, Moorthy RK, Mani S, Mathew V, Patil AK, Sivadasan A, Nair S, Joseph M, Thomas M, Prabhu K, Joseph BV, Rajshekhar V, Chacko AG. Decompressive craniectomy in cerebral venous thrombosis: a single centre experience. J Neurol Neurosurg Psychiatry. 2013;84(9):995–1000. https://doi.org/10.1136/jnnp-2012-303356.

    Article  PubMed  Google Scholar 

  24. Zuurbier SM, Coutinho JM, Majoie CB, Coert BA, van den Munckhof P, Stam J. Decompressive hemicraniectomy in severe cerebral venous thrombosis: a prospective case series. J Neurol. 2012;259(6):1099–105. https://doi.org/10.1007/s00415-011-6307-3.

    Article  PubMed  Google Scholar 

  25. Ferro JM, Crassard I, Coutinho JM, Canhão P, Barinagarrementeria F, Cucchiara B, Derex L, Lichy C, Masjuan J, Massaro A, Matamala G, Poli S, Saadatnia M, Stolz E, Viana-Baptista M, Stam J, Bousser MG, Second International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT 2) Investigators. Decompressive surgery in cerebrovenous thrombosis: a multicenter registry and a systematic review of individual patient data. Stroke. 2011;42(10):2825–31.

    Article  Google Scholar 

  26. Pfefferkorn T, Eppinger U, Linn J, et al. Long-term outcome after suboccipital decompressive craniectomy for malignant cerebellar infarction. Stroke. 2009;40:3045–50.

    Article  Google Scholar 

  27. Jüttler E, Schweickert S, Ringleb PA, et al. Long-term outcome after surgical treatment for space-occupying cerebellar infarction: experience in 56 patients. Stroke. 2009;40:3060–6.

    Article  Google Scholar 

  28. Kase CS, Williams JP, Wyatt DA, et al. Lobar intracerebral hematomas: clinical and CT analysis of 22 cases. Neurology. 1982;32:1146–50.

    Article  CAS  Google Scholar 

  29. Fujitsu K, Muramoto M, Ikeda Y, et al. Indications for surgical treatment of putaminal hemorrhage. Comparative study based on serial CT and time-course analysis. J Neurosurg. 1990;73:518–25.

    Article  CAS  Google Scholar 

  30. Brott T, Broderick J, Kothari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke. 1997;28:1–5.

    Article  CAS  Google Scholar 

  31. Volpin L, Cervellini P, Colombo F, et al. Spontaneous intracerebral hematomas: a new proposal about the usefulness and limits of surgical treatment. Neurosurgery. 1984;15:663–6.

    Article  CAS  Google Scholar 

  32. Mendelow AD, Gregson BA, Fernandes HM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the international surgical trial in intracerebral haemorrhage (STICH): a randomised trial. Lancet. 2005;365:387–97.

    Article  Google Scholar 

  33. Prasad K, Mendelow AD, Gregson B. Surgery for primary supratentorial intracerebral hematoma. A meta-analysis of 10 randomized controlled trials. Stroke. 2009;40:e624–6.

    Article  Google Scholar 

  34. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, STICH II Investigators. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 2013;382:397–408.

    Article  Google Scholar 

  35. Auer LM, Deinsberger W, Niederkorn K, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study. J Neurosurg. 1989;70:530–5.

    Article  CAS  Google Scholar 

  36. Broderick JP, Brott TG, Duldner JE, et al. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993;24:987–93.

    Article  CAS  Google Scholar 

  37. Zuccarello M, Brott T, Derex L, et al. Early surgical treatment for supratentorial intracerebral hemorrhage: a randomized feasibility study. Stroke. 1999;30:1833–9.

    Article  CAS  Google Scholar 

  38. Niizuma H, Shimizu Y, Yonemitsu T, et al. Results of stereotactic aspiration in 175 cases of putaminal hemorrhage. Neurosurgery. 1989;24:814–9.

    Article  CAS  Google Scholar 

  39. Morgan T, Awad I, Keyl P, et al. Preliminary report of the clot lysis evaluating accelerated resolution of intraventricular hemorrhage (CLEAR-IVH) clinical trial. Acta Neurochir Suppl. 2008;105:217–20.

    Article  CAS  Google Scholar 

  40. Lippitz BE, Mayfrank L, Spetzger U, et al. Lysis of basal ganglia haematoma with recombinant tissue plasminogen activator (rtPA) after stereotactic aspiration: initial results. Acta Neurochir (Wien). 1994;127:157–60.

    Article  CAS  Google Scholar 

  41. Schaller C, Rohde V, Meyer B, et al. Stereotactic puncture and lysis of spontaneous intracerebral hemorrhage using recombinant tissue plasminogen activator. Neurosurgery. 1995;36:328–33.

    Article  CAS  Google Scholar 

  42. Vespa P, McArthur D, Miller C, et al. Frameless stereotactic aspiration and thrombolysis of deep intracerebral hemorrhage is associated with reduction of hemorrhage volume and neurological improvement. Neurocrit Care. 2005;2:274–81.

    Article  Google Scholar 

  43. Hanley DF, Thompson RE, Rosenblum M, Yenokyan G, Lane K, McBee N, Mayo SW, Bistran-Hall AJ, Gandhi D, Mould WA, Ullman N, Ali H, Carhuapoma JR, Kase CS, Lees KR, Dawson J, Wilson A, Betz JF, Sugar EA, Hao Y, Avadhani R, Caron JL, Harrigan MR, Carlson AP, Bulters D, LeDoux D, Huang J, Cobb C, Gupta G, Kitagawa R, Chicoine MR, Patel H, Dodd R, Camarata PJ, Wolfe S, Stadnik A, Money PL, Mitchell P, Sarabia R, Harnof S, Barzo P, Unterberg A, Teitelbaum JS, Wang W, Anderson CS, Mendelow AD, Gregson B, Janis S, Vespa P, Ziai W, Zuccarello M, Awad IA, MISTIE III Investigators. Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet. 2019;393(10175):1021–32.

    Google Scholar 

  44. Naff N, Williams MA, Keyl PM, Tuhrim S, Bullock MR, Mayer SA, et al. Low-dose recombinant tissue-type plasminogen activator enhances clot resolution in brain hemorrhage: the intraventricular hemorrhage thrombolysis trial. Stroke. 2011;42:3009–16. https://doi.org/10.1161/STROKEAHA.110.610949.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Hanley DF, Lane K, McBee N, Ziai W, Tuhrim S, Lees KR, Dawson J, Gandhi D, Ullman N, Mould WA, Mayo SW, Mendelow AD, Gregson B, Butcher K, Vespa P, Wright DW, Kase CS, Carhuapoma JR, Keyl PM, Diener-West M, Muschelli J, Betz JF, Thompson CB, Sugar EA, Yenokyan G, Janis S, John S, Harnof S, Lopez GA, Aldrich EF, Harrigan MR, Ansari S, Jallo J, Caron JL, LeDoux D, Adeoye O, Zuccarello M, Adams HP Jr, Rosenblum M, Thompson RE, Awad IA, CLEAR III Investigators. Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial. Lancet. 2017;389(10069):603–11.

    Article  CAS  Google Scholar 

  46. Gaberel T, Magheru C, Parienti JJ, Huttner HB, Vivien D, Emery E. Intraventricular fibrinolysis versus external ventricular drainage alone in intraventricular hemorrhage: a meta-analysis. Stroke. 2011;42:2776–81. https://doi.org/10.1161/STROKEAHA.111.615724.

    Article  PubMed  Google Scholar 

  47. Bhattathiri PS, Gregson B, Prasad KS, Mendelow AD, STICH Investigators. Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial. Acta Neurochir Suppl. 2006;96:65–8.

    Article  CAS  Google Scholar 

  48. Kirollos RW, Tyagi AK, Ross SA, et al. Management of spontaneous cerebellar hematomas: a prospective treatment protocol. Neurosurgery. 2001;49:1378–86; discussion 1386–7.

    Article  CAS  Google Scholar 

  49. Weisberg LA. Primary pontinehaemorrhage: clinical and computed tomographic correlations. J Neurol Neurosurg Psychiatry. 1986;49:346–52.

    Article  CAS  Google Scholar 

  50. Rajshekhar V. Management of hydrocephalus in patients with tuberculous meningitis. Neurol India. 2009;57:368–74.

    Article  Google Scholar 

  51. Cairns H. Neurosurgical methods in the treatment of tuberculous meningitis. Arch Dis Child. 1951;26:376–83.

    Article  Google Scholar 

  52. Palur R, Rajshekhar V, Chandy MJ, et al. Shunt surgery for hydrocephalous in tubercular meningitis: a long-term follow-up study. J Neurosurg. 1991;74:64–9.

    Article  CAS  Google Scholar 

  53. Bhagwati S, Mehta N, Shah S. Use of endoscopic third ventriculostomy in hydrocephalus of tubercular origin. Childs Nerv Syst. 2010;26(12):1675–82.

    Article  Google Scholar 

  54. Chugh A, Husain M, Gupta RK, et al. Surgical outcome of tuberculous meningitis hydro-cephalus treated by endoscopic third ventriculostomy: prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy. J Neurosurg Pediatr. 2009;3:371–7.

    Article  Google Scholar 

  55. Sil K, Chatterjee S. Shunting in tuberculous meningitis: a neurosurgeon’s nightmare. Childs Nerv Syst. 2008;24:1029–32.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Sandeep Mohindra

  2. Department of Neurosurgery, Fortis Hospital, Noida, India

    Rahul Gupta

  3. Department of Neurosurgery, Asian Institute, Faridabad, Haryana, India

    Kamal Verma

Authors
  1. Sandeep Mohindra
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  2. Rahul Gupta
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  3. Kamal Verma
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Editor information

Editors and Affiliations

  1. Department of Neurology, All India Institute of Medical Sciences, New Delhi, India

    Mamta Bhushan Singh

  2. Department of Neurology, All India Institute of Medical Sciences, New Delhi, India

    Rohit Bhatia

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Mohindra, S., Gupta, R., Verma, K. (2019). Neurosurgical Interventions in Neurological Emergencies. In: Singh, M., Bhatia, R. (eds) Emergencies in Neurology . Springer, Singapore. https://doi.org/10.1007/978-981-13-7381-7_11

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  • DOI: https://doi.org/10.1007/978-981-13-7381-7_11

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