Úmrtí císaře Montezumy zřejmě na následky kraniocerebrálního poranění nepochybně předznamenalo konec aztécké říše. Ovšem vlastní pád aztécké říše zásadnějším způsobem ovlivnilo jiné kraniocerebrální poranění a především jeho úspěšná léčba - otevřená, zřejmě kontaminovaná impresivní fraktura kalvy španělského konquistadora Hernanda Cortése, o které překvapivě existují pouze omezené literární prameny. Po úspěšné operační léčbě se Hernando Cortés znovu ujal velení armády, se kterou dobyl aztécké hlavní město, a ukončil tak existenci aztécké říše. Jeho další výboje pak dostaly do španělského područí nejen velkou část Střední Ameriky s jejím bohatstvím, což ovlivnilo španělskou i světovou historii.
The death of Emperor Montezuma, apparently from craniocerebral injury, undoubtedly marked the end of the Aztec Empire. However, another craniocerebral injury affected the Aztec empire's downfall in a more fundamental way, and, above all, its successful treatment - the open, apparently contaminated, impresive calvarial fracture of Spanish conquistador Hernando Cortés, of which, surprisingly, there are only limited literary sources. After successful surgical treatment, Hernando Cortés resumed command of the army with which he captured the Aztec capital, ending the existence of the Aztec Empire. His other conquests then brought not only much of Central America with its riches into Spanish thrall, affecting not only Spanish but also world history.
- Keywords
- Montezuma, hernando Cortés,
- MeSH
- History, 16th Century MeSH
- Craniocerebral Trauma * surgery history MeSH
- Humans MeSH
- Neurosurgical Procedures history methods MeSH
- Trephining history MeSH
- Skull Fracture, Depressed surgery history MeSH
- Check Tag
- History, 16th Century MeSH
- Humans MeSH
- Publication type
- Historical Article MeSH
In this paper we present three prehistoric cases (two previously reported and one recently discovered) of trepanation from Croatia: Rudine, Bezdanjača and Jagodnjak, all dated to the Bronze Age. By using a detailed macroscopic analysis as well as radiographic imaging (x-ray and CT scanning) of the skulls, we provide a new assessment and interpretation for this type of surgical intervention during the Bronze Age. The first case was that of an adult male from the Rudine site dated to the Early Bronze Age; the second trepanation was recorded on an adult female from the Bezdanjača Cave, dated to the Middle/Late Bronze Age; the third case was observed on a juvenile cranium from the Jagodnjak site, dated to the Middle Bronze Age. All three cases exhibit several similarities: (i) all are located on the right side of the frontal bone; (ii) all three are of similar dimension/shape; (iii) in all cases all three layers of calvarium were breached; and (iv) similar techniques for trepanation procedure were used in all cases. These three crania represent the oldest cases of intentional medical interventions in the territory of modern-day Croatia, while the Jagodnjak individual is the youngest person thus far discovered with this kind of treatment in the region.
- Keywords
- pravěk, doba bronzová,
- MeSH
- History, Ancient * MeSH
- Adult MeSH
- Skull surgery injuries MeSH
- Humans MeSH
- Adolescent MeSH
- Trephining * history methods MeSH
- Check Tag
- History, Ancient * MeSH
- Adult MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Female MeSH
- Publication type
- Historical Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Croatia MeSH
Úvod: Cieľom štúdie je zhodnotiť vplyv trvania subdurálnej drenáže a počtu trepanačných otvorov na incidenciu recidívy unilaterálneho chronického subdurálneho hematómu (CHSH). Metódy: Retrospektívne sme analyzovali 65 pacientov po evakuácii unilaterálneho CHSH cez 1 alebo 2 trepanačné otvory s aplikáciou subdurálnej drenáže v období od januára 2014 do decembra 2018. Hodnotili sme vplyv počtu trepanačných otvorov a trvanie subdurálnej drenáže po operačnom výkone na incidenciu recidívy CHSH. Vzhľadom na trvanie subdurálnej drenáže sme rozdelili súbor na 2 podsúbory: 1–3 dni a 4–5 dní. Sledovali sme súčasne vplyv trvania subdurálnej drenáže na incidenciu infekčných komplikácií.Výsledky: Celková incidencia recidívy CHSH v súbore bola 18,5 %. Recidíva CHSH bola prítomná u 10 zo 45 pacientov (22,2 %) po evakuácii cez 1 trepanačný otvor a u 2 z 22 pacientov (9,1 %) po evakuácii cez 2 trepanačné otvory. Rozdiel nebol štatisticky významný (p=0,3214). Nebol zistený významný vplyv veku, pohlavia a trvania subdurálnej drenáže na incidenciu recidívy CHSH. Trvanie subdurálnej drenáže nemalo významný vplyv na výskyt infekčných komplikácií (p=0,0950).Záver: Počet trepanačných otvorov a trvanie subdurálnej drenáže nemá signifikantný vplyv na incidenciu recidívy unilaterálneho CHSH. Trvanie subdurálnej drenáže nemá významný vplyv na výskyt infekčných komplikácií.
Introduction: Purpose of the study is to evaluate a possible influence of subdural drainage duration and burr hole quantity on a relapse of a unilateral chronic subdural haematoma (CHSH).Methods: Sixty - five patients who underwent evacuation of unilateral CHSH via 1 or 2 burr holes and subdural drainage during a period from January 2014 to December 2018 were retrospectively analyzed. Duration of the subdural drainage and the number of burr holes used were assessed in relation to an incidence of CHSH recurrence. According to the subdural drainage duration, we divided the patient cohort into two subgroups: with the subdural drainage duration of 1–3 days and 4–5 days. We also evaluated a possible influence of the subdural drainage duration on risk of postoperative infection. Results: An overall incidence of CHSH recurrence was 18.5%. In 45 patients treated by means of a single burr hole the haematoma recurrence was observed in 10 patients (22.2%), in 22 patients with two burr holes recurrence occurred in 2 of them (9.1%). The difference was however, not statistically significant (p=0.3214). We did not observe any significant influence of age, gender and subdural drainage duration on the incidence of CHSH recurrence. The duration of subdural drainage had not significant impact on postoperative infection rate (p=0.0950).Conclusion: The number of burr holes used does not affect the rate of unilateral CHSH recurrence. Similarly the duration of subdural drainage affects neither the unilateral CHSH recurrence rate nor the incidence of postoperative infection.
PURPOSE: To analyze the reasons and patient-related and injury-related risk factors for reoperation after surgery for acute subdural hematoma (SDH) and the effects of reoperation on treatment outcome. METHODS: Among adult patients operated on for acute SDH between 2013 and 2017, patients reoperated within 14 days after the primary surgery were identified. In all patients, parameters were identified that related to the patient (age, anticoagulation, antiplatelet, and antiepileptic treatment, and alcohol intoxication), trauma (Glasgow Coma Score, SDH thickness, midline shift, midline shift /hematoma thickness rate, other surgical lesion, primary surgery-trephination, craniotomy, or decompressive craniotomy), and Glasgow Outcome Score (GOS). The reasons for reoperation and intervals between primary surgery and reoperation were studied. RESULTS: Of 86 investigated patients, 24 patients were reoperated (27.9%), with a median interval of 2 days between primary surgery and reoperation. No significant differences in patients and injury-related factors were found between reoperated and non-reoperated patients. The rate of primary craniectomies was higher in non-reoperated patients (P = 0.066). The main indications for reoperation were recurrent /significant residual SDH (10 patients), contralateral SDH (5 patients), and expansive intracerebral hematoma or contusion (5 patients). The final median GOS was 3 in non-reoperated and 1.5 in reoperated patients, with good outcomes in 41.2% of non-reoperated and 16.7% of reoperated patients. CONCLUSIONS: Reoperation after acute SDH surgery is associated with a significantly worse prognosis. Recurrent /significant residual SDH and contralateral SDH are the most frequently found reasons for reoperation. None of the analyzed parameters were significant reoperation predictors.
- MeSH
- Hematoma, Subdural, Acute epidemiology etiology surgery MeSH
- Anticoagulants therapeutic use MeSH
- Anticonvulsants therapeutic use MeSH
- Decompressive Craniectomy statistics & numerical data MeSH
- Adult MeSH
- Epilepsy drug therapy epidemiology MeSH
- Glasgow Coma Scale MeSH
- Glasgow Outcome Scale MeSH
- Platelet Aggregation Inhibitors therapeutic use MeSH
- Craniocerebral Trauma complications MeSH
- Craniotomy statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Neurosurgical Procedures statistics & numerical data MeSH
- Alcoholic Intoxication epidemiology MeSH
- Reoperation statistics & numerical data MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Sex Factors MeSH
- Trephining statistics & numerical data MeSH
- Age Factors MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Cíl: Existuje mnoho modifikací chirurgické léčby chronického subdurálního hematomu (CHSDH), nicméně v naprosté většině je prováděna trepanace s drenáží hematomu. Cílem naší studie bylo porovnat dva konkrétní operační postupy – trepanaci a drenáž s peroperačním výplachem hematomu a trepanaci s prostou drenáží. Soubor a metodika: Do studie byli zařazeni pacienti operačně léčení pro CHSDH na našem pracovišti v letech 2011– 2016. Do září roku 2013 byli pacienti léčeni trepanací s výplachem a drenáží, od té doby léčba spočívala jen v trepanaci a drenáži bez výplachu. Změna daného postupu na našem pracovišti byla ovlivněna studiemi prokazujícími obdobné výsledky obou operačních postupů. Rozdělení pacientů dle operačního postupu tedy není zatíženo selekčním bias. Veškeré údaje nutné pro zhodnocení operačních postupů se zaměřením především na hodnocení počtu recidiv byly retrospektivně vyhledány v lékařské dokumentaci. Výsledky byly statisticky zpracovány. Výsledky: Do studie bylo zařazeno 230 pacientů, kteří byli léčeni jedním ze dvou studovaných postupů. Z 81 pacientů, kteří podstoupili operaci s výplachem, došlo k recidivě u 19 pacientů (23,5 %), z toho 4 pacienti (4,9 %) museli následně podstoupit i kraniotomii s exstirpací pouzdra. Chirurgické řešení bez výplachu podstoupilo 149 pacientů, u 42 pacientů (28,2 %) se rozvinula recidiva, z toho 9 pacientů (6,0 %) muselo podstoupit kraniotomii s exstirpací pouzdra. Statistické vyhodnocení neprokázalo signifikantní rozdíl mezi oběma chirurgickými postupy stran efektivity léčby. Závěr: Provedení prosté trepanace a drenáže při léčbě CHSDH je dle dosavadních výsledků stejně účinné jako standardně prováděná trepanace s výplachem a drenáží. Postup bez výplachu, jako méně invazivní a rychlejší, se tedy jeví vhodnější při chirurgické léčbě CHSDH.
Aim: There are a lot of modifications for the surgical treatment of chronic subdural haematoma; however, the burr hole drainage is the most common procedure. The aim of our study was to compare two particular surgical procedures: burr hole drainage with preoperative irrigation of the haematoma and simple burr hole drainage. Patients and methods: Patients who were operated on the chronic subdural haematoma at our department between 20112016 were enrolled in the study. Burr hole drainage with irrigation was used till September 2013; since then, patients have undergone burr hole drainage without irrigation. This change in surgical technique at out department was influenced by the studies showing similar results of both surgical techniques. Thus, the distribution of patients according to the surgical technique was not influenced by selection bias. All the data needed for the evaluation of the results of both surgical techniques, especially focusing on assessing recurrences, were found retrospectively in the medical documentation. Results: There were 230 patients in our study who were treated by one of two study procedures. Eightyone patients underwent surgery with irrigation of haematoma, out of which 19 patients (23.5%) developed recurrence and 4 patients (4.9%) had to finally undergo craniotomy and membranectomy. The surgical technique without irrigation of haematoma was performed in 149 patients, and the recurrence was observed in 42 patients (28.2%) and 9 patients (6.0%) had to undergo craniotomy and membranectomy. Statistical evaluation did not prove a significant difference in effectiveness between these two surgical techniques. Conclusion: Simple burr hole drainage is as effective as burr hole drainage with irrigation according to up to date knowledge. The technique without irrigation, as less invasive and faster, seems to be better for the treatment of chronic subdural haematoma.
- MeSH
- Hematoma, Subdural, Chronic * surgery MeSH
- Drainage methods MeSH
- Therapeutic Irrigation methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Recurrence MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Trephining methods MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
Chronický subdurální hematom představuje jedno z nejčastějších onemocnění, se kterým se setkáváme v běžné neurochirurgické praxi. Diagnózu chronického subdurálního hematomu obvykle stanoví neurologové, ale s pacienty s danou diagnózou se běžně setkávají i lékaři jiných odborností. Cílem sdělení je poskytnout ucelený přehled o etiologii, patogenezi, klinických projevech, diagnostice a léčbě tohoto onemocnění s ohledem na nejnovější poznatky a zkušenosti autorů.
Chronic subdural haematoma represents one of the most frequent diseases which we deal with in common neurosurgical practice. Diagnosis of chronic subdural haematoma is usually determined by a neurologist, but patients with this diagnosis are commonly seen even by other specialists. The aim of this article is to provide a complete overview of etiology, pathophysiology, clinical presentation, diagnostics and treatment of this disease with regard to up to date knowledge and authors´ experience.
- Keywords
- subdurální kolekce, hyperfibrinolýza,
- MeSH
- Hematoma, Subdural, Chronic * diagnosis etiology surgery MeSH
- Humans MeSH
- Neuroimaging methods MeSH
- Tomography, X-Ray Computed methods MeSH
- Postoperative Complications MeSH
- Trephining methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Thirty-two skeletons from burial ground Bakheri chala were analysed macroscopically and X-ray for pathological conditions such as trepanation, traumatic injuries, infectious disease and dental pathology. This study has shown that average age at death was relatively high. Trepanation with rectangular sawing for the first time found in the Armenia at two individuals. Trauma to the skull was common, which suggests a high level of inter-personal violence. We here report a case of decapitation. Bakheri chala site showed a high frequency of auditory exostosis. The dental pathology conditions of this population were numerous. Agriculture introduced people to carbohydrates, or sugars, which affect the teeth and cause dental caries. The staple diet of ancient population from Shnogh river consisted of wine, bread, vegetables, and fruits. Males do show a slightly higher rate of wear than females possibly suggesting a greater proportion of bread in the diet of males.
BACKGROUND: Chronic subdural hematoma (CSDH) is a common neurosurgical condition with an increasing incidence. Standard treatment of CSDHs is surgical evacuation. The objective of this study is to present a modification of standard burr-hole hematoma evacuation using a flexible endoscope and to assess the advantages and risks. METHODS: Prospectively, 34 consecutive patients diagnosed with CSDH were included in the study. Epidemiological, clinical and radiographical data were collected and reviewed. All patients underwent a burr-hole evacuation of CSDH. A flexible endoscope was inserted and subdural space inspected during surgery. The surgeon was looking specifically for the presence of septations, draining catheter position and acute bleeding. RESULTS: Thirty-four patients underwent 37 endoscope-assisted surgeries. Presenting symptoms were hemiparesis (79%), decreased level of consciousness (18%), gait disturbances (15%), headache (12%), aphasia (6%), cognitive disturbances (6%) and epileptic seizure (3%). Average operative time was 43 min, and the average increase in operative time due to the use of the endoscope was 6 min. Recurrence rate was 8.8%, and clinical outcome was favorable (defined as mRS ≤ 2) in 97% of the cases. CONCLUSIONS: To our knowledge, the present cohort of 34 patients is the largest group of patients with CSDH treated using an endoscope. This technique allows decent visualization of the hematoma cavity while retaining the advantages of a minimally invasive approach under a local anesthesia. The main advantages are correct positioning of the catheter under visual control, identification of septations and early detection of cortex or vessel injury during surgery.
- MeSH
- Headache etiology MeSH
- Hematoma, Subdural, Chronic surgery MeSH
- Adult MeSH
- Drainage methods MeSH
- Endoscopy instrumentation methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Minimally Invasive Surgical Procedures methods MeSH
- Postoperative Complications MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Subdural Space surgery MeSH
- Trephining methods MeSH
- Consciousness MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Úvod: Chronický subdurální hematom je potenciálně závažné onemocnění postihující především nemocné vyššího věku, často se závažnými komplikujícími onemocněními a rozsáhlou medikací včetně antiagregační a antikoagulační terapie. U symptomatických nemocných je nutná operace – nejčastěji evakuace hematomu z trepanace s drenáží subdurálního prostoru. Cílem studie je rozbor vlivu předoperační antikoagulační nebo antiagregační terapie u nemocných s chronickým subdurálním hematomem na tíži předoperační klinické symptomatologie a výsledek operační léčby včetně četnosti komplikací a reoperací. Materiál a metodika: Práce retrospektivně analyzuje soubor 132 nemocných, operovaných v letech 2008–2013 na pracovišti autorů pro chronický subdurální hematom. U nemocných byly sledovány následující parametry charakterizující předoperační stav: věk, podávaná antikoagulační nebo antiagregační léčba, jiné poruchy hemokoagulace, interval mezi pravděpodobným úrazem a operací, délka trvání příznaků, stav nemocného před výkonem (Glasgow Coma Scale) a přítomnost zřejmé fatické poruchy nebo motorického deficitu alespoň středního stupně. V peri a pooperačním průběhu byl hodnocen typ výkonu, přítomnost recidivy hematomu, způsob reoperace, pooperační komplikace a výsledný stav nemocného hodnocený pomocí Glasgow Outcome Scale. Výsledky: Do souboru bylo zařazeno 64 nemocných (42 mužů, 22 žen) bez antiagregační, antikoagulační a jiné medikace ovlivňující hemokoagulaci a s normálními laboratorními parametry (kontrolní soubor), 20 nemocných (13 mužů, 7 žen) s účinnou warfarinizací a 37 nemocných s antiagregační terapií (30 mužů, 7 žen). Nemocní s antiagregační terapií a warfarinizovaní pacienti byli významně starší než pacienti v kontrolním souboru. U warfarinizovaných nemocných statistické hodnocení prokázalo významně kratší dobu trvání klinických příznaků a významně horší předoperační klinický stav při hodnocení pomocí Glasgow Coma Scale. S jedinou výjimkou byly u všech nemocných primárně indikovány trepanace s drenáží, u nemocných s antiagregační terapií nebo na warfarinu po adekvátní hematologické přípravě. I když byla četnost reoperací pro recidivu hematomu a pooperačních komplikací nejvyšší u warfarinizovaných nemocných, rozdíl proti kontrolnímu souboru nedosahoval statistické významnosti. Hodnocení klinického výsledku s odstupem alespoň 2 měsíců po operaci prokazuje srovnatelný podíl dobrých výsledků (Glasgow Outcome Scale 4,5) ve všech skupinách − 82,8 % v kontrolním souboru, 80 % u warfarinizovaných a 83,8 % nemocných s antiagregační terapií. Závěr: Získaná data neprokázala statisticky významný negativní vliv antikoagulační nebo antiagregační terapie na výsledky neurochirurgické léčby po adekvátní předoperační přípravě u nemocných s chronickým subdurálním hematomem při hodnocení podle Glasgow Outcome Scale. Výsledky prokazují nejvyšší četnost komplikací a recidiv chronických subdurálních hematomů u nemocných na warfarinu, i když rozdíl nedosahuje statistické významnosti.
Introduction: Chronic subdural haematoma is a potentially threatening disease, affecting mainly advanced age patients often with frequent serious complicating diseases and extensive concomitant medication including antiaggregation and anticoagulation treatment. Surgery is indicated in symptomatic patients, with haematoma evacuation and subdural drainage via simple skull trephination in the majority of cases. The study aims to analyse the influence of presurgical anticoagulation and antiaggregation treatment on the severity of pre-surgical clinical status and final surgical outcome including the incidence of complications and haematoma recurrence. Material and methods: The paper retrospectively analyses a group of 132 patients operated on from 2008 to 2013 for chronic subdural haematoma. The following parameters characterising pre-surgical clinical condition were studied: age, anticoagulation and antiaggregation treatment administered, other haemocoagulation problems, interval between the probable injury and surgery, duration of symptoms, the patient’s pre-surgical clinical condition (Glasgow Coma Scale) and the presence of a speech disorder or at least moderate limb paresis. In the postoperative period and subsequent follow- up, the type of surgery, haematoma recurrence, reoperation technique, postoperative complications and final outcome (Glasgow Outcome Scale) were analysed. Results: 64 patients (42 males, 22 females) without antiaggregation and anticoagulation treatment or other medication potentially altering haemocoagulation with normal coagulation parameters (control group), 20 patients (13 males, 7 females) on anticoagulation and 37 patients (30 males, 7 females) on antiaggregation met study inclusion criteria. Anticoagulated patients and patients on antiaggregation were significantly older than the control group patients. Statistical analysis also proved a shorter duration of clinical symptoms and worse clinical condition (GCS) in anticoagulated patients than in the control group. Skull trephination with drainage was the primary surgery indicated in all but one patient, in patients with anticoagulation or antiaggregation after adequate haematological treatment. Although the incidence of reoperation due to haematoma recurrence and postoperative complications was the highest in anticoagulated patients, this difference from the control group did not reach the level of statistical significance. The analysis of clinical outcome (>2 months after surgery) shows a similar proportion of patients with good outcome (Glasgow Outcome Scale 4.5) in all studied groups – control group 82.8%, anticoagulation treatment 80%, antiaggregation treatment 83.8%. Conclusion: Study results did not confirm statistically a significant negative effect of antiaggregation or anticoagulation treatment after adequate pre-surgical preparation on surgical outcomes in chronic subdural haematoma patients (Glasgow Outcome Scale). The highest incidence of complications and haematoma recurrencies was found in anticoagulated patients, although the difference does not reach the level of statistical significance.
- MeSH
- Anticoagulants administration & dosage adverse effects MeSH
- Time Factors MeSH
- Hematoma, Subdural, Chronic * diagnosis surgery MeSH
- Adult MeSH
- Drainage MeSH
- Glasgow Coma Scale statistics & numerical data MeSH
- Glasgow Outcome Scale statistics & numerical data MeSH
- Platelet Aggregation Inhibitors * administration & dosage adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Neurosurgical Procedures MeSH
- Brain Injuries MeSH
- Preoperative Period MeSH
- Preoperative Care * MeSH
- Recurrence MeSH
- Reoperation statistics & numerical data MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Statistics as Topic MeSH
- Trephining methods MeSH
- Treatment Outcome MeSH
- Warfarin * administration & dosage adverse effects MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
