Tag: Chronic

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Chronic Oculomotor Nerve Palsy Presentation From Posterior Communicating Artery Aneurysm

Operative Neurosurgery 30:703–710, 2026

This case series analyzes 17 patients with subacute to chronic oculomotor nerve palsy (ONP) caused by posterior communicating artery (PCoA) aneurysms treated between 1991 and 2024. Demographics, aneurysm characteristics, treatment modalities (clipping vs endovascular), and follow-up outcomes are reported, highlighting that only a minority presented with rupture.

The report finds that complete ONP recovery occurred exclusively in patients treated within five weeks of symptom onset, supporting early definitive management to maximize functional nerve recovery despite chronic ONP not reliably predicting imminent aneurysm rupture.

Clinical question: The natural history of chronic oculomotor nerve palsy (ONP) from posterior communicating artery (PCoA) aneurysm is unclear, especially regarding rupture risk and likelihood of nerve recovery when symptoms persist beyond 1 week.

Cohort & design: Case series from a prospectively accrued institutional database (1991–2024) including patients with ≥1 week ONP attributed to PCoA aneurysm; patients with <1 week onset, inadequate follow-up, or other causes of ONP were excluded.

Patient profile: 17 patients; predominantly female (94.1%), median age 56; ONP duration ranged 1 week to 10 years; 29.4% presented with aneurysm rupture.

Treatment approaches: Most were treated with microsurgical clipping (64.7%) or endovascular therapy (29.4%); one patient was managed conservatively due to comorbidities/limited life expectancy.

ONP recovery outcomes: Complete ONP recovery occurred in 23.5% (4/17); all complete recoveries were in patients with symptom duration <5 weeks.

Timing signal: Subacute ONP (<5 weeks) was associated with better recovery (including complete recovery), while chronic ONP (≥5 weeks) had no complete recoveries in this cohort.

Rupture implication: Chronic ONP appeared not to indicate imminent rupture, with only about one-third presenting ruptured and an example of 10 years of stable ONP preceding rupture in the longest-duration case.

Management takeaway: Even if chronic ONP may not predict near-term rupture, early definitive aneurysm treatment is still recommended to maximize the chance of functional ONP recovery.

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Recurrent Chronic Subdural Hematoma After Burr-Hole Surgery and Postoperative Drainage

Operative Neurosurgery 25:216–241, 2023

Reported recurrence rates of chronic subdural hematoma treated by burr-hole surgery with postoperative drainage vary considerably in the literature. We performed a systematic review and meta-analysis to define the recurrence rate of burr-hole surgery with postoperative drainage.

METHODS: PubMed and EMBASE were searched, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. We used the Newcastle-Ottawa scale and Cochrane risk-of-bias tool for quality assessment of included studies and the random-effects model to calculate pooled incidence rates in R with the metaprop function if appropriate.

RESULTS: The search yielded 2969 references; 709 were screened full text, and 189 met the inclusion criteria. In 174 studies (34 393 patients), the number of recurrences was reported as per patient and 15 studies (3078 hematomas) reported the number of recurrences per hematoma, for a pooled incidence of 11.2% (95% CI: 10.3-12.1; I 2 = 87.7%) and 11.0% (95% CI: 8.6-13.4; I 2 = 78.0%), respectively. The pooled incidence of 48 studies (15298 patients) with the highest quality was 12.8% (95% CI 11.4-14.2; I 2 = 86.1%). Treatment-related mortality (56 patients) has a pooled incidence of 0.7% (95% CI 0.0-1.4; I 2 = 0.0%).

CONCLUSION: The recurrence rate of chronic subdural hematoma treated by burr-hole surgery and postoperative drainage is 12.8%.

 

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Management of Chronic Subdural Hematoma: A Systematic Review and Component Network Meta-analysis of 455 Studies With 103 645 Cases

Neurosurgery 91:842–855, 2022

Chronic subdural hematoma (CSDH) is a common neurosurgical condition with a high risk of recurrence after treatment.

OBJECTIVE: To assess and compare the risk of recurrence, morbidity, and mortality across various treatments for CSDH.

METHODS: A systematic review and meta-analysis was performed. PubMed/MEDLINE, EMBASE, SCOPUS, and Web of Science were searched from January 01, 2000, to July 07, 2021. The primary outcome was recurrence, and secondary outcomes were morbidity and mortality. Component network meta-analyses (CNMAs) were performed for surgical and medical treatments, assessing recurrence and morbidity. Incremental risk ratios (iRRs) with 95% CIs were estimated for each component.

RESULTS: In total, 12 526 citations were identified, and 455 studies with 103 645 cases were included. Recurrence occurred in 11 491/93 525 (10.8%, 95% CI 10.2-11.5, 418 studies) cases after surgery. The use of a postoperative drain (iRR 0.53, 95% CI 0.44-0.63) and middle meningeal artery embolization (iRR 0.19, 95% CI 0.05-0.83) reduced recurrence in the surgical CNMA. In the pharmacological CNMA, corticosteroids (iRR 0.47, 95% CI 0.36- 0.61) and surgical intervention (iRR 0.11, 95% CI 0.07-0.15) were associated with lower risk. Corticosteroids were associated with increased morbidity (iRR 1.34, 95% CI 1.05-1.70). The risk of morbidity was equivalent across surgical treatments.

CONCLUSION: Recurrence after evacuation occurs in approximately 10% of cSDHs, and the various surgical interventions are approximately equivalent. Corticosteroids are associated with reduced recurrence but also increased morbidity. Drains reduce the risk of recurrence, but the position of drain (subdural vs subgaleal) did not influence recurrence. Middle meningeal artery embolization is a promising treatment warranting further evaluation in randomized trials.

 

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Dexamethasone for chronic subdural haematoma: a systematic review and meta-analysis

Acta Neurochir (2017) 159:2037–2044

Chronic subdural haematoma is a common but retractable neurological disease in the elderly with a high rate of recurrence. Dexamethasone (DX) either as monotherapy or adjuvant therapy has been applied clinically, but its effectiveness and feasibility remain controversial. We conducted this review to clarify this issue. Methods With a systematic review through multiple databases, we retrieved eligible English language publications and extracted relevant data to perform meta-analyses. The respective risk ratio (RR) and its 95% confidence interval (CI) were pooled to evaluate the overall effect. Results Our meta-analysis showed overall that DX (alone or adjuvant) resulted in a lower recurrence rate when compared with non-DX therapy (RR, 0.54; 95% CI, 0.33-0.88; p = 0.01), but sensitivity analysis by excluding the most influential study achieved inconsistent results. The pooled effect revealed no statistical difference

Methods With a systematic review through multiple databases, we retrieved eligible English language publications and extracted relevant data to perform meta-analyses. The respective risk ratio (RR) and its 95% confidence interval (CI) were pooled to evaluate the overall effect. Results Our meta-analysis showed overall that DX (alone or adjuvant) resulted in a lower recurrence rate when compared with non-DX therapy (RR, 0.54; 95% CI, 0.33-0.88; p = 0.01), but sensitivity analysis by excluding the most influential study achieved inconsistent results. The pooled effect revealed no statistical difference

Results Our meta-analysis showed overall that DX (alone or adjuvant) resulted in a lower recurrence rate when compared with non-DX therapy (RR, 0.54; 95% CI, 0.33-0.88; p = 0.01), but sensitivity analysis by excluding the most influential study achieved inconsistent results. The pooled effect revealed no statistical difference on recurrence rate between DX alone and non-DX therapy or surgical therapy (RR, 0.86; 95% CI, 0.43-1.71; p = 0.66) (RR, 0.89; 95% CI, 0.43-1.85; p = 0.76). Comparison between DX alone with the surgical therapy demonstrated no difference on the poor outcome (RR, 0.40; 95% CI, 0.15-1.04; p = 0.06). Conclusions We had

Conclusions We had no enough evidence to support DX use as an effective alternation to surgical therapy. But adjuvant DX use may facilitate the surgical therapy by reducing recurrence. Further study focusing on adjuvant DX was required.

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The surgical management of chronic subdural hematoma

Neurosurg Rev DOI 10.1007/s10143-011-0349-y

Chronic subdural hematoma (cSDH) is an increasingly common neurological disease process. Despite the wide prevalence of cSDH, there remains a lack of consensus regarding numerous aspects of its clinical management. We provide an overview of the epidemiology and pathophysiology of cSDH and discuss several controversial management issues, including the timing of postoperative resumption of anticoagulant medications, the effectiveness of anti-epileptic prophylaxis, protocols for mobilization following evacuation of cSDH, as well as the comparative effectiveness of the various techniques of surgical evacuation.

A PubMed search was carried out through October 19, 2010 using the following keywords: “subdural hematoma”, “craniotomy”, “burr-hole”, “management”, “anticoagulation”, “seizure prophylaxis”, “antiplatelet”, “mobilization”, and “surgical evacuation”, alone and in combination. Relevant articles were identified and back-referenced to yield additional papers. A meta-analysis was then performed comparing the efficacy and complications associated with the various methods of cSDH evacuation.

There is general agreement that significant coagulopathy should be reversed expeditiously in patients presenting with cSDH. Although protocols for gradual resumption of anti-coagulation for prophylaxis of venous thrombosis may be derived from guidelines for other neurosurgical procedures, further prospective study is necessary to determine the optimal time to restart fulldose anti-coagulation in the setting of recently drained cSDH. There is also conflicting evidence to support seizure prophylaxis in patients with cSDH, although the existing literature supports prophylaxis in patients who are at a higher risk for seizures.

The published data regarding surgical technique for cSDH supports primary twist drill craniostomy (TDC) drainage at the bedside for patients who are high-risk surgical candidates with non-septated cSDH and craniotomy as a first-line evacuation technique for cSDH with significant membranes. Larger prospective studies addressing these aspects of cSDH management are necessary to establish definitive recommendations.

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