RESUMEN
Out of a consecutive series of 1082 operations performed on head-injured patients over a 9-year period, 28 cases of acute subdural haematomas (SDHs) or epidural haematomas (EDHs) occurring in patients aged between 80 and 100 years were selected. Mortality rates in these patients (100% in 2 EDHs, 88% in 26 SDHs) were significantly higher (p less than 0.01) compared with patients under 80 years (12% in 308 EDHs, 57% in 215 SDHs). Pre-existing diseases, primary events precipitating falls, and multiple system failure complicating the postoperative course accounted for most of the deaths. None of the patients operated upon with a Glasgow Coma Scale score of 11 or less survived. A typical 'talk and die' course occurred in two cases. Three patients, all operated on for SDH, survived and returned to their pre-injury conditions. It was concluded that, whilst the question as to whether to submit very old comatose patients to life-prolonging measures remains unsettled, there is a case for the prompt evacuation of extra-axial clots in patients with minimal impairment of consciousness.
Asunto(s)
Anciano Frágil/estadística & datos numéricos , Hematoma Epidural Craneal/cirugía , Hematoma Subdural/cirugía , Complicaciones Posoperatorias/mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Hematoma Epidural Craneal/mortalidad , Hematoma Subdural/mortalidad , Humanos , Masculino , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
In order to assess the actual incidence of gas bubbles trapped within acute intracranial epidural haematomas, as revealed by computed tomography (CT) of the skull, a series of 204 patients with surgically verified epidural haematomas was retrospectively reviewed. Gas bubbles were observed on CT scan in 22.5% of the cases, with the incidence rising to 37% when CT scanners of the last generation were employed. The available data failed to demonstrate the actual source of intracranial gas. No correlation was found between the presence of gas bubbles and outcome. No patient in the whole series showed any sign of intracranial infection.
Asunto(s)
Hematoma Epidural Craneal/complicaciones , Neumocéfalo/complicaciones , Enfermedad Aguda , Hemorragia Cerebral/complicaciones , Escala de Coma de Glasgow , Hematoma Epidural Craneal/diagnóstico por imagen , Humanos , Neumocéfalo/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Real-time ultrasound was used to assist localization and surgical removal of ten cases of tumours of pineal region and third ventricle. Two illustrative cases are reported in which intraoperative ultrasound greatly facilitates the surgical procedure.